Produced by K.D. Thornton, Jason Isbell, Josephine Paolucci
and the Online Distributed Proofreading Team at
http://www.pgdp.net








[Illustration: _By courtesy of The New York Times_

NEW YORK'S BETTER BABY

Little Hiss Johanna Wiggers, who won the first prize in New York's
Better Babies Contest by scoring 100 points, is the type of little girl
that will make the best mothers, and the better race tomorrow. Her score
card showed; age, 28 months; weight, 33 lbs. 14 ozs.; height, 35-1/2
inches; circumference of head, 19-1/2 inches: circumference of chest, 20
inches; lateral diameter of chest, 6 inches; diameter of chest from
front to back, 4-1/2 inches; length of arm to tip of middle finger,
14-1/2 inches; length of leg to the sole of the foot, 16-1/2 inches;
total, 100 points.]




The Eugenic Marriage

A Personal Guide to the New Science of Better Living and Better Babies

By W. GRANT HAGUE, M. D.

_College of Physicians and Surgeons (Columbia University), New York;
Member of County Medical Society, and of the American Medical
Association_

In Four Volumes

VOLUME II

New York

THE REVIEW OF REVIEWS COMPANY

1914

     Copyright, 1913, by
     W. GRANT HAGUE

     Copyright, 1914, by
     W. GRANT HAGUE




TABLE OF CONTENTS



SEX HYGIENE FOR THE BOY

CHAPTER XII

BUILDING OUR BOYS

PAGE

A word to parents--Interest in sex hygiene--The "Social Evil"--Ten
millions suffering with venereal diseases in the United
States--Immorality not confined to large cities--Venereal diseases
common in country places--What are the consequences of venereal disease
to the boy?--Gonorrhea, or clap--Symptoms of gonorrhea in the
male--Complications of gonorrhea--Syphilis, or the "pox"--How syphilis
is acquired--Syphilis attacks every organ in the body--Not possible to
tell when cured--The chancre--Systematic, or constitutional
symptoms--Mucous patches and ulcers--Syphilis of the blood vessels and
lymphatic glands--The interior organs--Brain and spinal cord--The nose,
eye, ear, throat--Hair and nails--What the boy with venereal disease may
cause in others--The infected wife--A girl's fate when she
marries--Young wife rendered sterile--Young wife made to miscarry--Is
the husband to blame--Building the man--Age of puberty--"Internal
Secretion" ... PAGE 139


CHAPTER XIII

THE PARENTS AND THE BOY

Abuse of the procreative function--The continent life--Provide the
environment necessary to the clean life--The period of procreative
power--Self-abuse--Masturbation--Treatment of masturbation--Night losses
or wet dreams--Causes of night emissions--Sexual excesses--Treatment of
sexual excesses--What parents should know about the so-called "social
evil" before speaking with authority to the boy--The need of
enlightenment in sexual matters--"No one told me, I did not know"--Fake
medical treatment of venereal diseases--Sowing wild oats--Should
circumcision be advised ... PAGE 153


SEX HYGIENE FOR THE GIRL

CHAPTER XIV

A MOTHER'S DUTY TO HER DAUGHTER

What a mother should tell her little girl--Where do babies come
from--How baby birds and fish come from eggs--How other animals have
little nests of their own--The duty of mothers to instruct and
direct--What a mother should tell her daughter--Every mother should
regard this duty as sacred--Every female child is a possible future
mother--Motherhood the highest function of the sex--Health the one
necessary essential--Symptoms of the first, or beginning
menstruation--The period of puberty in the female--Changes in the
reproductive organs at puberty--The female generative organs--The
function of the reproductive organs--The age of puberty in the
female--The function of the ovary--The function of the womb--Why
menstruation occurs every twenty-eight days--The male or papa egg--The
function of the spermatozoa--"Tell the whole story"--"How do these
spermatozoa get there"--The union of the species--"How can a baby live
in there for such a long time"--How the baby gets its nourishment in the
womb--Girls must not become mothers ... PAGE 173


CHAPTER XV

PREPARING FOR MOTHERHOOD

Menstruation--Irregular menstruation--Changes in the quantity
of the flow--How the womb is held in place--Symptoms of
menstruation--Menstruation should not be accompanied with pain--Don't
give your daughters patent medicines, or "Female Regulators"--Take your
daughter to the doctor--Leucorrhea in girls--Bathing when
menstruating--Constipation and displaced wombs--Dress and
menstruation--Absence of menstruation, or amenorrhea--Treatment of
amenorrhea--Painful menstruation, or dysmenorrhea--Causes of
dysmenorrhea--Treatment of dysmenorrhea--Sterility in the
female--Conditions which affect the fertility of women--Climate, station
in life, season of the year, age, the tendency to miscarry--Causes of
sterility in the female--Displacement of womb--Diseases of womb,
ovaries, or tubes--Malformations--Lacerations--Tumors--Leucorrhea--Physical
debility--Obesity--Special poisons--"Knack of miscarrying"--Miscarriage--Cause
of miscarriage--The course and symptoms of miscarriage--What to do
when a miscarriage is threatened--Treatment of threatened
miscarriage--Treatment of inevitable miscarriage--After
treatment of miscarriage--The tendency to miscarriage ... PAGE 187


THE BABY

CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE BABY

What to prepare for the coming baby--Care of the newly-born baby--The
first bath--Dressing the cord--Treatment after the cord falls off--A
pouting navel--Bathing baby--Clothing the baby--Baby's night
clothes--Care of the eyes--Care of the mouth and first teeth--Care of
the skin--Care of the genital organs--Amusing baby--Temperature
in children--The teeth--The permanent teeth--Care of the
teeth--Dentition--Treatment of teething--How to weigh the baby--Average
weight of a male baby--Average weight of a female baby--Average height
of a male child--The rate of growth of a child--Pulse rate in
children--Infant records, why they should be kept--"Growing
pains" ... PAGE 209


CHAPTER XVII

BABY'S FEEDING HABITS

Overfeeding baby--Intervals of feeding--How long should a baby stay at
the breast--Vomiting between feedings--Regularity of feeding--Why is
regularity of feeding important--A baby never vomits--What is the
significance of so-called vomiting after feedings--Mother's milk that is
unfit for baby--Fresh air for baby--Air baths for baby ... PAGE 223


CHAPTER XVIII

BABY'S GOOD AND BAD HABITS--FOOD FORMULAS

Baby's bed--The proper way to lay baby in bed--Baby should sleep by
itself--How long should a baby sleep--Why a baby cries--The habitual
crier--The habit of feeding baby every time it cries--The habit of
walking the floor with baby every time it cries--Jouncing, or hobbling
baby--Baby needs water to drink--The evil habit of kissing
baby--Establishing toilet habits--Baby's comforter--What can be done to
lessen the evil effects of the comforter habit--Beef juice--Beef juice
by the cold process--Mutton broth--Mutton broth with cornstarch or
arrowroot--Chicken, veal, and beef broths--Scraped beef or meat
pulp--Junket or curds and whey--Whey--Barley water--Barley water gruel
or barley jelly--Rice, wheat or oat water--Imperial Granum--Albumen
water--Dried bread--Coddled egg ... PAGE 235


ARTIFICIAL FEEDING

CHAPTER XIX

ARTIFICIAL FEEDING

Elementary principles of milk modification--The secret of the efficiency
of mothers' milk--Two important factors in successful artificial
feeding--Every child is a problem in itself--Proprietary foods of little
value as infant foods--Their value is in the milk added to them--The
credit belongs to the cow--Difference between human and cow's milk--What
"top-milk" feeding means--Utensils necessary for home modification of
milk--Artificial feeding from birth to the twelfth month--How to
measure "top-milk"--Easy bottle-feeding method--Condensed milk
feeding--Objections to condensed milk feeding ... PAGE 249


CHAPTER XX

ARTIFICIAL FEEDING (_continued_)

How to prepare milk mixtures--Sterilizing the food for the day's
feeding--How to test the temperature of the food for baby--When to
increase the quality or quantity of food--Food allowable during the
first year in addition to milk--Beef-juice--White of egg--Orange
juice--Peptonized milk--The hot or immediate process--The cold
process--Partially peptonized milk--Completely peptonized milk--Uses of
peptonized milk--Objections to peptonized milk--What a mother should
know about baby's feeding bottle and nipple--Should a mother put her
baby on artificial food if her supply of milk during the first two weeks
is not quite enough to satisfy it--Certain conditions justify the
adoption of artificial feeding from the beginning--Mothers' mistakes in
the preparation of artificial food--Feeding during the second
year--Sample meals for a child three years of age--The diet of older
children--Meats, vegetables, cereals, bread, desserts, fruits ... PAGE 259


WHAT MOTHERS SHOULD KNOW

CHAPTER XXI

THE EDUCATION OF THE MOTHER

What mothers should know about the care of children during illness--A
sick child should be in bed--The diet of the sick child--A child is the
most helpless living thing--The delicate child--How to feed the delicate
child--How to bathe the delicate child--Airing the delicate
child--Habits of the delicate child--Indiscriminate feeding--Poor
appetite--Loss of appetite--Treatment of loss of appetite--Overeating in
infancy--What correct eating means--Bran as a food--Breakfast for a
child at school--Lunch for a child at school--Bran muffins for school
children--Bran muffins in constipation--Hysterical children--What a
mother should know about cathartics and how to give a dose of castor
oil--Castor oil--Calomel--Citrate of Magnesium--When to use castor
oil--When to use calomel--Vaccination--Time for vaccination--Methods of
vaccination--Symptoms of successful vaccination ... PAGE 277


CHAPTER XXII

CONSTIPATION IN INFANTS AND CHILDREN

Constipation--Regularity of bowel function--The function of the
stomach--Fermentation--Incomplete constipation--Importance of a clean
bowel--A daily movement of the bowel necessary--Constipation in
breast-fed infants--Treatment of constipation in breast-fed
infants--Constipation in bottle-fed infants--Treatment of constipation
in bottle-fed infants--Constipation in children over two years of
age--Diet list for constipation in children--Bran muffins in
constipation--Treatment of obstinate constipation--Oil injections in
constipation ... PAGE 303


CHAPTER XXIII

CONSTIPATION IN WOMEN

Chief cause of constipation in women--Constipation a cause of domestic
unhappiness--The requirements of good health--The cost of
constipation--Constipation and social exigencies--One of the important
duties of mothers--Constipation and diseases of women--Constipation is
always harmful--Constipation and pregnancy--Explanation of incomplete
constipation--Causes of constipation--Negligence--Lack of exercise--Lack
of water--Lack of bulk in the food taken--Abuse of cathartic drugs and
aperient waters--Overeating--Treatment of constipation in
women ... PAGE 315




SEX HYGIENE FOR THE BOY




CHAPTER XII

     "The evil that men do lives after them. The good is often
     interred with them."

     "The pleasure in living is to meet temptation and not yield to
     it." Elmer Lee, M. D.

BUILDING OUR BOYS

     A Word to Parents--Interest in Sex Hygiene--The "Social
     Evil"--Ten Millions Suffering with Venereal Diseases in the
     United States--Immorality not Confined to Large
     Cities--Venereal Diseases Common in Country Places--What Are
     the Consequences of Venereal Disease to the Boy?--Gonorrhea, or
     Clap--Symptoms of Gonorrhea in the Male--Complications of
     Gonorrhea--Syphilis, or the "Pox"--How Syphilis is
     Acquired--Syphilis Attacks Every Organ in the Body--Not
     Possible to Tell When Cured--The Chancre--Systematic or
     Constitutional Symptoms--Mucous Patches and Ulcers--Syphilis of
     the Blood Vessels and Lymphatic Glands--The Interior
     Organs--Brain and Spinal Cord--The Nose, Eye, Ear, Throat--Hair
     and Nails--What the Boy with Venereal Disease May Cause in
     Others--The Infected Wife--A Girl's Fate When She
     Marries--Young Wife Rendered Sterile--Young Wife Made to
     Miscarry--Is the Husband to Blame?--Building the Man--Age of
     Puberty--"Internal Secretion."


A WORD TO PARENTS.--Within recent times the subject of sex hygiene has
been freely discussed by members of the medical profession and through
them the general public has been made more or less acquainted with the
problem. It has therefore acquired a degree of genuine interest which
speaks well for the future of the eugenic ideal. Eugenics is based to a
very large extent upon the principles underlying sex hygiene.

As a result of this widespread interest and investigation, we have
discovered that the only method that promises actual progress, is to
talk plainly and to tell the actual truth. The day of the prude has
passed. To attempt to achieve results in the education of youth in sex
problems, without giving, facts, is wasted effort. To give facts we must
explain each problem so that its principles may be clearly understood
and its meaning grasped. To point out the duty of youth is not
sufficient. They must be shown why it is to their best interest to live
the clean life. In every department of education we are beginning to
appreciate that to achieve results it must be based upon the individual
equation. This is why we have found it necessary to assert that it is
the duty of parents to make sex hygiene a personal matter and to
acquaint their children with the facts relating to this problem. It has
been discovered, however, that a very large percentage of parents are
inadequately informed on these subjects, in fact they know practically
nothing about the actual facts which they are supposed to teach. I shall
try to tell the story in a way which every parent will understand.

When a boy reaches the age of puberty he is susceptible to sexual
desire. If he has not been told the story of his growth from boyhood to
man's estate he will either begin to abuse himself, or he will be later
enticed to commit himself to intercourse with some unclean female and he
will acquire a disease as a result.

Inasmuch as it has been asserted that practically every boy has been
addicted to self-abuse at some time, and that eighty per cent. of all
males, between the ages of sixteen and thirty years, are victims of
venereal disease, it would seem justifiable to assume that the boys who
are informed of the facts in time are the boys who constitute the
percentage who escape. This, of course, may not be literally true, but
it is a reasonable assumption.

While self-abuse is a pernicious habit and may be attended with serious
consequences, it is not a disease and, as will be explained later, it
can be cured. It is therefore a menace to the individual, not to the
race, and consequently need not concern us at the present time. On the
other hand the venereal diseases are not to be considered as individual
problems since they affect the welfare of the race. The venereal
diseases which we will consider are gonorrhea and syphilis.

THE SOCIAL EVIL.--It has been estimated that there are more than _ten
millions_ of people in this country to-day suffering from the effects of
venereal diseases. In New York city alone, there are _two million_
victims suffering from the direct or indirect consequences of these
diseases. It has been authoritatively asserted that, out of every ten
men between the ages of sixteen and thirty, eight have, or have had, one
or other of these diseases. When it is remembered that these diseases
are not merely temporary incidents, but that they may be regarded as
practically incurable in the vast majority, because of antagonistic
social conditions and ignorance, and that they are highly infectious, we
may begin to realize how important they are from the standpoint of race
regeneration.

Statistics of these conditions are never reliable because much of the
evil is hidden and lied about. It is quite probable,--if the estimates
were based upon absolute knowledge--that the extent of the prevalency of
these diseases would be greatly increased rather than reduced. It is
however a fact, that the combined ravages of the Great White Plague,
leprosy, yellow fever, and small-pox, are merely incidents compared to
the effects which the venereal diseases have had upon mankind. It is
useless to think that these diseases can be driven out of the land. Any
hope of this nature is the impression of the dreamer. By a propaganda of
education, by the spread of the eugenic idea and ideal, we may, however,
reasonably hope to minimize the evil and, at least, to protect the
innocent.

THE SOURCES OF IMMORALITY.--It is a fallacious idea to assume that the
sources of immorality are confined to the large cities. This is far from
the truth. In smaller towns and country places the diseases are quite
common and conditions there tend to the spread of the contagion in a
more intimate and a more harmful way. The individuals who are most
likely to become affected are those most liable to succumb to temptation
and whose home ties are of the best. There are many instances on record
where one or two loose women spread the infection all over the country
communities, infecting boys and men alike. No one can estimate what the
final effect of such an epidemic may mean or how many innocent
individuals may have their lives wrecked as a direct consequence. It is
because these consequences are the product of ignorance in a very large
percentage of the cases that there is such urgent need for
enlightenment. It is at least our plain duty to tell the boy the actual
facts--to post him with reference to consequences. The more thoroughly
we instruct him in the elementary facts relative to the venereal
diseases, the safer he will be from temptation, and if he possesses this
knowledge and acquires disease, he will be more likely to immediately
seek competent aid and advice.


WHAT ARE THE CONSEQUENCES OF VENEREAL DISEASE TO THE BOY HIMSELF?

GONORRHEA OR "CLAP."--This is the most frequent of the venereal
diseases. It is also the most serious. It is an unfortunate fact, that
in the past,--and even to-day--boys have been told that gonorrhea is no
worse than "a bad cold." This lie has been responsible for much evil and
a great amount of unnecessary suffering and misery.

Gonorrhea is caused by a germ, obtained, as a rule, during intercourse
with an infected person. This germ is called gonococcus. It thrives on
any mucous membrane; it is not, therefore, limited to the sexual organs.
For this reason it may attack any part of the body where mucous membrane
is. It is particularly liable to damage, sometimes seriously and
permanently, the eye. It may be spread from one person to another, or
from any infected article to a person in numerous ways. The innocent may
thus suffer as a result of the carelessness of the vicious.

THE SYMPTOMS OF GONORRHEA IN THE MALE are slight itching and burning of
the mouth of the urethra. This is noticeable at any time from the third
to the fourteenth day after exposure. These symptoms become more
pronounced and a slight discharge appears. The patient is compelled to
urinate frequently and it is painful and difficult. The discharge
increases, it becomes thicker and looks like ordinary yellow pus. If the
case is a severe one, the discharge may be blood stained, and if this
symptom is present urination is more painful and more frequent.

In about ten days the disease reaches its height; it remains stationary
for a number of weeks and then slowly, seemingly, gets better. The
discharge grows thinner, less in quantity and lighter in color. It may
refuse, despite the most careful and efficient treatment, to stop
altogether; it is then known as "gleet." If the discharge stops
completely the patient is apparently cured, as far as any external
manifestation of the disease is concerned. _In seventy-five per cent. of
the cases, however, this apparent cure is no cure at all, as will be
seen later._

Certain complications are likely to arise in the course of gonorrhea.
The infection itself may be of such an acute or virulent type, that it
invades the deeper structures of its own accord and despite the most
careful, competent treatment; or if the treatment is not adequate or
skillful it may be forced backward; or through neglect in not beginning
the right kind of treatment in times, a simple infection may grow in
degree into a serious disease, and invade the more important structures.
In this way are produced disease of the bladder, prostate gland, seminal
vesicles, testicles, and of the kidneys. Gonorrheal rheumatism may
follow, and even disease of the lining membrane of the heart, and death.

When disease of the deeper parts occur the patient is frequently
incapacitated and compelled to go to bed. He may have chills, fever and
sweats, intense pain and the passage of bloody urine. He may have to be
operated upon, and his general health may be permanently wrecked. So
long as the germs are present there is danger despite the most
scientific treatment. It is not the quality of the treatment that is at
fault, it is the presence of the germs; and since it is impossible to
pursue any certain method of eradication, we must continue treatment--as
long as the germs are present--and hope for favorable results. The
infection may last for many years. The germs having found entrance into
the small tubes in the interior organs they can only be dislodged with
difficulty, if at all. These pockets of germs may be excited to renewed
activity by sexual intercourse, or by injury to the parts, and may
reinfect the patient at any times. In a very considerable number of
these cases where the deeper structures are involved, the patient may
recover from the acute or painful period of the disease, only to find
that he is sterile. There are many such cases, and the most vindictive
individual who may believe that every who sins should be punished will
admit that sterility, as the price of a moment's forgetfulness, is a
terrible fee to pay.

SYPHILIS, OR THE "POX," is an infectious, germ blood disease. It is most
frequently acquired through sexual intercourse.

It may be acquired by direct contact with a diseased person. In order to
render such contact effective, it is essential that the skin of the
healthy person be abraded, or the contact may be directly on a mucous
membrane, as the mouth in the act of kissing.

It may be acquired by using any article which has been used by a
syphilitic, as a drinking cup, or towel.

It may be acquired through hereditary transmission.

Surgeons frequently contract syphilis while operating on, or examining
patients who have the disease. Dentists may convey it by means of
instruments which have not been rendered aseptic, or thoroughly clean.
Using a towel which has been used by a syphilitic has many times
conveyed the infection to an innocent party. For this reason the roller
towel has been done away with, and some states have legislated against
its use in hotels and other public places. To use dishes, spoons,
tobacco pipe, beer glasses, etc., which have been used by one having the
disease is an absolutely certain way of being infected. Cigars which may
have been made by a syphilitic will infect whoever smokes them with the
virus of the disease. Syphilis has been known to have been caught from
using the church communion cup. The public drinking-cup has been a
prolific source of syphilitic dissemination to innocents. Legislators
are just waking up to the danger that lurks in this institution and it
will no doubt be done away with, not only in public places, but on all
railroad and steamboat lines.

An infected mother can transmit syphilis to her child. If the father is
affected, but not the wife, the child may escape.

Syphilis attacks every organ in the human body. The actual degree of
infection has no relation to the size or character of the external
manifestations. The external evidence may be minute and insignificant,
while the internal extent and ravages of the disease may be tremendous
and of large proportions. Many men when asked regarding incidents of the
long ago, may state, "Oh, yes, I had a chancre twenty-five years ago,
but it was a very small affair and soon healed up and was cured." Yet
that same little chancre, that made only a mild impression on the man's
mind, may, and most probably will, be the direct cause of that man's
death.

It is not possible to tell with absolute certainty that an individual is
suffering with syphilis by any known test. The most recent one--the
Wassermann test--is not absolute by any means.

The first symptoms, or what is known as the initial lesion of syphilis,
is the chancre.

THE CHANCRE is a small, hard tumor, or it may be a small ulcer with a
hard base, or it may simply appear as a thin small patch on any mucous
membrane. It is not painful, it can be moved if taken between the
fingers, showing it is not attached to the deep structures, and when it
is so moved it is not tender or sore. Any little lump which ulcerates
located on the genitals must be regarded with suspicion. Boys and men
should not be satisfied with any offhand statement that, "it is
nothing." It may be a chancre, and it may be exceedingly serious if not
properly diagnosed.

Systemic, or constitutional symptoms, begin to show themselves any time
from the sixth to the tenth week after the appearance of the chancre.

ERUPTIONS OF THE SKIN characterize every case of syphilis. They occur in
all degrees from the mild rash to the foul ulcer. The ulcerative process
is very often extensive and loathsome.

MUCOUS PATCHES AND ULCERS affect the mucous membranes. The mouth and
throat are favorite locations for these lesions. They occur in the anus
and rectum, and may be mistaken in that region for other serious
conditions. Men who drink and smoke suffer as a rule severely from
mucous patches in the mouth and throat.

Syphilis attacks the blood vessels and the lymphatic glands. These cases
may have been unrecognized, and may have existed for many years. A man
may die from a rupture of a blood vessel in the brain during middle life
as a consequence of a forgotten, supposedly cured case of syphilis many
years before.

THE INTERIOR ORGANS may be attacked by syphilis. As a result we get
disease of the liver, heart, stomach, kidneys, lungs, and other parts.
It has been suggested that many diseases affecting these organs, for
which treatment proves unsatisfactory, may have had their origin in a
former syphilis.

THE BRAIN AND SPINAL CORD are quite often the seat of syphilitic
affections. A tumor, known by the name of "gumma," is the result. The
blood vessels of the entire nervous system may be affected and, as a
consequence, we often see cases of paralysis, apoplexy, epilepsy,
locomotor ataxia and death.

THE NOSE, EYE, EAR, THROAT, are frequently very seriously compromised as
a result of the syphilitic poison. Deformity, caused by rotting of the
bones of these parts is not infrequent. Loss of voice, or smell, or
hearing, or sight, may result.

THE HAIR AND NAILS may fall out. The bones may ulcerate and rot. The
organs of procreation usually participate in the degenerative process.
Virility is destroyed, and impotence is quite common after a severe
attack.


WHAT THE BOY WITH VENEREAL DISEASE MAY CAUSE IN OTHERS

GONORRHEA.--When the average boy acquires gonorrhea he frequently does
not know, for many weeks, that he is the victim of a dangerous,
infectious disease. He appreciates probably, that it relates to the
sexual indiscretion he was guilty of, and feels that it is something to
be ashamed of. He therefore hides his condition, confides in no one, and
blindly hopes it will get better somehow or at some time. Meantime the
disease, which may have been mild at the beginning, is gradually gaining
ground and strength, and his neglect may eventuate in lifelong misery.
No means are taken to guard against spreading the infection, the
discharge may lodge on his fingers and he may infect his eyes and may
lose his sight because he did not know that the discharge is one of the
most dangerous fluids known. It may get on water-closet seats and infect
others. Eventually he is compelled to seek aid, and he may, after a long
period, be freed from the immediate consequences of his folly. At a
later date he marries, and as previously explained, he infects his wife.
This is the beginning of much of the domestic infelicity that is so
prevalent to-day, and, inasmuch as it is a subject that should be
thoroughly understood by every woman and mother, I shall carefully and
clearly explain its significance and its consequences.

Let us first, however, briefly consider what may occur to others if the
boy is unfortunate enough to acquire syphilis. Again the boy fails to
comprehend the nature of his affliction. There is imminent danger of the
members of his household becoming infected. He uses the same dishes,
spoons, towels, and utensils, any one of which may convey the disease to
his father, mother, sister, or brother. He may use the common drinking
glass in school, college, or office, and spread the disease in this way.
He may kiss any member of his family, or a baby, and infect them. He may
have his hair cut, or be shaved, and the virus may be spread around in
this way if the barber does not sterilize the article used,--which he
never does. He may drink at a soda fountain, or at a saloon, and the
next individual to use the same glass may acquire the disease. He is a
menace to the individual, to the community, and to the race. Wives often
acquire syphilis from their husbands.

THE INFECTED WIFE.--It has been previously stated that eight out of
every ten males between the ages of sixteen and thirty, have had or
have, gonorrhea or syphilis. Seventy-five per cent. of these cases have
not been cured. About thirty-five per cent. of these are destined to
infect wife, or wife and children, and in all probability many others.

If a young wife acquires infection from her husband, she is exactly in
the same condition as the diseased boy,--she does not know what ails
her, so she wastes precious time in unprofitable worry. Why should she
know what the trouble is? She came to the marriage bed pure, and clean,
and healthy. Her previous education did not include instruction which
would even help her to guess what the trouble might be. She is simply
conscious of new distressing conditions which she does not understand.
She may try to believe that these conditions are incidental to the
change in her life. Shortly, however, the discharge, which she has had
for a number of weeks, and which she thought was only a leucorrhea, or
"the whites," becomes so profuse and nasty that she begins douching.
This procedure simply blinds her to the true nature of the affection,
and in the end she is driven, ashamed and reluctant, to consult a
physician. She may be informed that her condition is bad, and that it
will be necessary that she submit to a course of treatment. After a time
the physician may succeed in tiding her over the immediate consequences
of the gonorrheal infection she innocently acquired. She may soon after
become pregnant, and she may miscarry as a result of the old trouble, or
she may carry the child the full period. When the child is born it may
be blind and this defect is a consequence of the old infection to the
mother from the father. If the mother is syphilitic the child most
likely will inherit all the horrible possibilities of transmitted
blood-poison.

Pregnancy frequently "lights up" any old, gonorrheal infection in the
female, so this young wife fails to completely recover after the
confinement. She is able to be about, but her strength refuses to be
restored. It may be months later when she begins to suffer pain and to
realize that she is quite sick. She develops a fever and may have a
chill. The physician discovers that she has pus in her tubes and there
is danger of peritonitis or general blood poisoning. The old germs have
been roused and are active. Unfortunately they are located where it is
impossible to dislodge them without resorting to a serious operation. It
is now a problem of saving her life. She is taken to the hospital and
her womb, tubes, and ovaries, are removed--she is unsexed.

Young wives are being operated on every day, in every city in the
civilized world for just such causes. It is a notorious fact, that, in
every city in the world, the number of operations that are daily being
performed on women, is increasing appallingly. Every surgeon knows that
eighty per cent. of these operations are caused, directly or indirectly,
by these diseases, and in almost every case in married women, they are
obtained innocently from their own husbands. It is rare to find a
married woman who is not suffering from some ovarian or uterine trouble,
or some obscure nervous condition, which is not amenable to the ordinary
remedies, and a very large percentage of these cases are primarily
caused by infection obtained in the same way.

When a girl marries she does not know what fate has in store for her,
nor is there any possible way of knowing, under the present marriage
system. If she begets a sickly, puny child,--assuming she herself has
providentially escaped immediate disease,--she devotes all her mother
love and devotion to her child, but she is fighting a hopeless fight as
I previously explained when I stated that one-half of the total effort
of one-third of the race, is expended in combating conditions against
which no successful effort is possible. Even her prayers are futile,
because the wrong is implanted in the constitution of the child and the
remedy is beyond her power to find. These are the tragedies of life,
which no words may adequately describe, and compared to which the
incidental troubles of the world at large are as nothing.

If the conditions are not as bad as those depicted above, the original
infection may have rendered her sterile. If the germs reached the womb
and tubes, the inflammatory process may close these tubes, with the
result that conception is impossible. In these cases the woman has to
bear the stigma and disgrace of a childless union, though she is not
the guilty party. Many husbands are sterile, however, as a result of
venereal disease. It is claimed that eighty per cent. of childless
marriages are caused by sterility of the male partner. Curiously and
unfortunately these men never suspect themselves. The wife is the
delinquent member, in their estimation. She is the victim of jest and
suspicion, and later of jibes and insults. Many women have had their
lives rendered miserable and unhappy because of this suspicion. They are
compelled by their husbands to submit to examination and unpleasant and
painful treatment and operations with the intention of rectifying a
defective condition that does not exist. Many conscientious physicians
refuse to treat women patients against whom the charge of sterility is
made, before subjecting the husbands to thorough examination, and, since
eighty per cent. of childless marriages are due to sterility in the
male, this is a just and reasonable course to pursue.

During the course of all this domestic trouble and tragedy, the young
wife's health has suffered--she scarcely enjoys one day of good health.
Her mental condition is even worse. She submits to innuendo and insult
under the impression that she is the unwitting cause of all the domestic
wretchedness and often wishes she had never entered the marriage state.
We must remember that these conditions wreck ideals and homes, and that
they frequently render inefficient both husband and wife. The economic
business of marriage becomes a failure, ambition is crushed and hope
dies in the heart.

If the mother has been inoculated with the virus of syphilis her
existence is equally wretched; her health is ruined; her efficiency is
forever mortgaged. If she becomes pregnant she will most likely abort
and she will go on aborting for years, in the effort to bring children
into the home, accusing herself meantime and submitting to the
reflections which are heaped upon her, while the real culprit is the
husband. He assumes an injured and innocent attitude and behaves as if
he had been imposed upon by marriage with a woman who cannot carry out
her marital contract.

If she gives birth to a child or children, they are syphilitic. They
may be deformed, or they may be feeble-minded or idiots. They may live
at home for years, always ailing, always sick. They may develop
epilepsy, St. Vitus' dance, skin disease, or mental vagaries, and they
may have to be put into institutions for the feeble-minded, or they may
die by inches at home.

IS THE HUSBAND TO BLAME?--If a boy had gonorrhea a number of years
before entering the marriage state, was treated for it by a physician,
until all symptoms had disappeared and had enjoyed apparent good health
in the interim, and had never been told any of the facts regarding
probable consequences, is it just to blame him if he infects his wife?
It is certain no man would willingly subject his bride to the risk of
infection, with all its horrible consequences. These conditions exist as
a result of the prudish attitude of society in the past toward all
questions affecting sex hygiene. We have not told all the truth to the
boy. Whatever knowledge he may have had was gained from companions, or
from individuals who knew the garbled facts only. There is of course no
excuse for the man who acquires disease after marriage and conveys it to
his wife or children. This is a very different situation and one which
should merit the severest condemnation and punishment. We are, however,
only interested in the boy at present and will not take up the reader's
time with a discussion of the "social evil" from this standpoint.

BUILDING A MAN.--When the boy is about fifteen years of age certain
changes begin to manifest themselves. He grows more rapidly, a growth in
which his whole system participates. His bones grow bigger and stronger,
his muscles increase in size, even his heart, and lungs, and liver, and
his digestive system accommodate themselves to this transformation; the
voice changes and hair begins to grow on his face. The mental process
also keeps pace with the new order of things. He thinks differently and
he sees from a new viewpoint. Nature is making a man out of a boy.

These changes were not understood in the past, but we are beginning to
appreciate the reason for this evolutionary process. We have discovered
that the cause depends upon certain active changes which take place in
the sex organs. About this time the testicles begin to be active. For
years these glands have been preparing themselves for this work, so they
first grow rapidly, increasing in size until they are about eight times
bigger than they were before this time, then they begin to pour into the
circulation a secretion which stimulates changes in all other parts of
the body and is directly responsible for the wonderful change that is
evident in the stature of the boy's body.

This substance or "internal secretion" must not be confused with the
semen. The internal secretion is simply the substance which nature
employs in the developing process and is responsible for the degree of
growth and quality of manhood which the boy manifests. The semen, on the
other hand, is the procreative or fertilizing fluid which enables a man
to beget offspring. When a boy understands this process it aids him in
appreciating the importance of his sex organs and a little thought
enables him to understand that if he abuses these organs he will
seriously interfere with his own development. This process goes on for a
number of years, until the boy reaches maturity. Any act or habit which
weakens the quality of this secretion will deplete his powers and render
him physically and mentally inefficient. To make a man, nature must be
permitted to work in her own way. You cannot improve on her methods nor
can you break her laws with impunity.




CHAPTER XIII

THE PARENTS AND THE BOY

     Abuse of the Procreative Function--The Continent Life--Provide
     the Environment Necessary to the Clean Life--The Period of
     Procreative Power--Self-abuse--Masturbation--Treatment of
     Masturbation--Night Losses or Wet Dreams--Causes of Night
     Emissions--Sexual Excesses--Treatment of Sexual Excesses--What
     Parents Should Know About the So-called "Social Evil," Before
     Speaking with Authority to the Boy--The Need of Enlightenment
     in Sexual Matters--"No One Told Me, I Did Not Know"--Fake
     Medical Treatment of Venereal Diseases--Sowing Wild
     Oats--Should Circumcision be Advised?


ABUSE OF THE PROCREATIVE FUNCTION.--Breeders of animals have discovered
that to breed from very young stock is not good. The quality and stamina
of the progeny is lowered and the vitality of the parent stock is
reduced. It is not a good economic proposition.

Boys should therefore be taught that any form of sexual indulgence is
harmful before the period of full growth.

Nature did not intend that the procreative function should be exercised
by individuals who were not fully developed. The perpetuation of the
species must not depend upon the license of immaturity. The instinct of
sex-attraction must not be debased to serve a puerile, rather than a
holy purpose.

Sexual indulgence in any form, and in any degree, at any age prior to
full maturity is a perversion of the primal instinct of race
perpetuation. The practice has a more intimate and a more personal
association with growing boys, however, than a merely altruistic
reference. Any indulgence of this character at this time is physically
and mentally injurious. No boy can hope ever to acquire the full measure
of his possible development as an efficient working or thinking machine
if he wastes his vital forces in unnatural liberties. He should be
taught this truth in an emphatic manner by those responsible for his
education.

There is a false idea prevalent that a continent life is harmful. So far
as continence relates to immaturity, it may be strongly and justly
asserted that it is probably the most important factor in the
conservation of health and strength. The retention of the procreative
fluids, at a time when nature is opposed to their loss, enables the
growing economy to utilize them in the conservation of nervous energy
and virility. If a boy dissipates these energizing fluids, he deprives
his body of the richest products which he is capable of manufacturing at
a time when he needs every aid in the building up of a physically and
mentally sound and vigorous constitution. There cannot exist a normal
development if the body is deprived of the essential ingredients
necessary to growth and mental vigor.

There was a time when young men were actually taught that sexual
intercourse was necessary to develop full manhood. This was followed by
a period of silence, which has practically extended to recent times.
Both of these systems are pernicious. We know that sexual intercourse is
not necessary to the development of mature normal manhood or womanhood.
On the contrary, we know that continence, not incontinence, is an
absolute essential to the growth of full sexual, virile maturity, as
well as to the growth of efficient and healthy manhood and womanhood.

We must appeal to a boy's reason and show him the personal side of clean
living. When he understands that to attain success in every department
of human effort,--on the baseball and football fields, in the ring, in
gymnastic contents, in examinations, in social intercourse, in trades
and professions,--a continent life is the only means possible that
promises success, he will give the appeal consideration.

We must employ all the safety devices possible to guard against the
inclination of youth to wander. Regular exercise is one of the very best
institutions in this respect. If we can instill into our boys a love of
manly sports and encourage every effort in this direction, we will be
doing much to minimize the growth of any tendency toward incontinence.
We must provide the environment necessary to right living. The home
should be attractive and we should permit the boy to have privileges
even at the expense of the housekeeping decorum. His companions should
be made welcome if they are the right kind of intimates, and the parents
should enter into the life of the boy and try to look at "things" from
his standpoint.

THE PERIOD OF PROCREATIVE POWER.--The procreative ability begins at
puberty. There is no fixed period at which it may be said to end. From
puberty until the period of physical maturity, it grows in vigor and it
remains stationary until middle life, when it gradually declines. The
standard of virility is unquestionably an individual problem. It depends
upon the various factors that contribute to good health and longevity.
It may be stated that the boy who abused his procreative function,
during the period of immaturity, will not enjoy, during the mature
period of his sexual life, a normal standard of vigor, nor will he carry
the ability into old age, to the same relative degree, as he would, and
as he had the innate promise to do--if he had led a normal continent
existence. It may also be stated here that there is no effective
remedial measures known, that will "bring back" the procreative ability
if it is lost as a result of disobeying natural laws. Drugs and
treatments by quacks to cure impotence are impositions and fakes. Money
and time spent in the pursuit of this dream is money and time wasted.

SELF-ABUSE OR MASTURBATION.--By self-abuse is meant the production of
the venereal orgasm, with or without emission, by any means other than
the natural union of the sexes.

It is a fact that the large majority of boys acquire the habit of
self-abuse at some time. This is a very serious reflection upon parent,
teacher, and physician, because it is through ignorance of the
elementary principles of sex hygiene that this condition continues to
exist. If they were warned against the possibility of self-abuse
arising in innocent ways, as well as in more reprehensible ways, they
would exert their influence against its acquirement. If however a boy
discovers accidentally a condition of which he was innocent, and of
which he does not know the significance, it is human nature that he
should investigate the phenomenon and in the end suffer as a
consequence. In the effort to relieve some local irritation he may
handle himself and be led into a dangerous practice. He does not know
that the practice may have serious results--in fact he does not know he
is doing anything wrong. Many boys have practically ruined their
physical health and become morally irresponsible because no one--neither
parent, teacher, physician, nor friend--told them of their danger. This
is unjust, but great strides are being made in this direction and we may
reasonably hope, that in the not far distant future, every boy will be
plainly told the true facts about himself.

Most boys acquire this habit from other boys, but as we have intimated
it is possible to acquire it in what are termed innocent ways. Sometimes
the sensation which leads to it is discovered by sliding down banisters;
or it may be that climbing trees or poles first awakens the feeling.
Very young children are sometimes taught the vice by depraved nurses.
Local irritation, as has been stated, may necessitate itching and
handling the parts and in this way the vice is begun. The results are
the same, no matter how the habit may have originated.

If the habit is persisted in, the muscular system suffers,--the muscles
become weak and flabby; the patient develops weariness and languor and
loses his mental and physical vigor. He is no longer forceful or
energetic, his efficiency is impaired and as a consequence his nervous
system begins to show signs of depleted strength. He cannot concentrate
his thoughts, he falls behind in his studies, his mental effort is
sluggish, he becomes diffident and shy, shuns society, loses confidence
in himself, is morbid and emotional and may even think of suicide.

It is astonishing how indulgence in this habit may affect the moral
nature of a boy. First of all, he is no longer frank and open. He
becomes shifty and suspicious and will not look you squarely in the
face. A boy cannot become a slave to this habit without it affecting his
mind. He invites debasing thoughts,--the old pure and clean method of
thought and living no longer satisfy. His imagination even becomes
corrupt and his moral nature and moral sense is perverted until he no
longer seems to be able to tell the difference between right and wrong.
He has little regard for the truth and if occasion demands it he will
lie without appreciating the dishonorable part he is playing. In the end
his will power is lost--even the effort to save himself is too feeble to
succeed--he is a slave to the habit, his health and strength ruined.

If every boy could realize the possible end of this evil habit he would
make an effort to rid himself of it before he becomes its victim and its
slave. It may be easy to abandon the practice in the beginning. The
longer he continues it, however, the less chance he has of finally
mastering it, until, if he persists beyond a certain point, it is a
matter of serious question whether he will ever be able to free himself
from its grip. If the boy has lost the will power to carry out his
resolves, no number of good desires or resolutions will avail. And it is
just this will power that the wasting of the semen saps little by little
away.

TREATMENT.--What can we do for these boys? Most of them can do much for
themselves by simply stopping the practice. There are, of course, others
who need careful management before the habit may be controlled and
health restored. It is well to always remember to be tactful and patient
and kind to these boys. Many of them are standing on the brink of
despair, weak in body and weak in mind. They do not know where to turn
to look for a friend--the right kind of a friend. It is a terrible
thought that your own boy may be abjectly miserable in his own home
because he is harboring a secret that is wrecking his health, and,
though he may long for sympathy and a helping hand, neither his father
nor mother have invited his confidence or spoken to him about these
things. A watchful mother can usually tell when her boy becomes addicted
to this habit. He will show it in his manner, he will not be free and
open, he will want to be by himself. Later he will show the effects of
the abusive treatment he is subjecting himself to in his appearance. He
will be sunken-eyed, pimply-faced, pasty-skinned, shiftless, sneaking,
silent, unmanly. No mother can fail to note these signs and she should
suspect the cause and take steps to tactfully reach him before he has
ruined his health absolutely.

We would advise regular exercise of a vigorous kind. Tire out the body
so that sleep may be sound. Cold baths, followed by brisk rub-downs; no
intoxicants, light meals, plenty of drinking water morning and night.
The bowels should be regular every day. He should sleep alone on a hard
bed in a well-aired room with light covering. He should keep busy every
minute of the day and he should not think of himself at all.

The boy must realize that his salvation rests with himself. After he
knows the real danger which the habit carries with it, he must be on his
guard every moment to abstain. If he does not he may rest assured that
the practice will ruin his health, render him, a business failure and
deprive him of all happiness during the rest of his life.

NIGHT LOSSES OR "WET-DREAMS."--A so-called wet-dream is an unconscious
emission of semen during sleep. The discharge may or may not be
accompanied with an erotic dream.

After a certain age--which may be from the twelfth or fourteenth year--a
boy may discover that he has discharged some substance during his sleep.
He finds the discharge on his night clothes and it naturally puzzles him
greatly. He may be entirely unconscious of the whole proceeding, having
slept soundly during the night, or he may wake up to find the fluid
actually discharging.

If a boy has not been told of this phenomenon he may regard it as a form
of self-abuse of which he may have heard and as a consequence he may
worry himself sick, as the night emissions continue to occur from time
to time. Many pure-minded boys have been rendered miserable, and their
efficiency and health have suffered as a result of just such an
experience. It is, therefore, proper that they should fully understand
the true significance of these occurrences.

CAUSES OF NIGHT EMISSIONS.--I have explained how nature makes a man out
of a boy. During this maturing process the testicles are very active
organs--their function is to manufacture or secrete the fertilizing
fluid or semen. This maturing process begins actively, as I stated,
about the age of fifteen, though in some boys it frequently occurs
earlier, sometimes as early as the twelfth year. When the testicle
begins to grow at this time they manufacture more semen than the little
pockets can hold, so nature adopts the method of permitting the surplus
to escape during sleep. These night emissions, therefore, are perfectly
natural losses, and need cause absolutely no distress of mind whatever.
The frequency with which they may occur depends altogether upon the
temperament of the boy. If the boy is a strong, active, athletic boy,
they may not be so frequent in him as they may be in a quiet, studious
boy. The system of the athletic boy seems to utilize more of this
surplus than the quieter existence of the studious boy calls for. If the
discharge does not occur oftener than once every two weeks, it may be
regarded as normal and natural. Should they become more frequent than
this, the boy should inform his mother or father and the family
physician should be consulted. It may be that he is in need of a tonic,
or special instructions regarding his method of living and his mode of
exercising. Whatever the cause may be, it can be corrected, and the best
plan is to give it attention as soon as it is noted that the losses are
too frequent.

SEXUAL EXCESSES.--It is well known to the medical profession that the
marital relation is frequently practiced to excess. The same indictment
may be passed on what may be termed extra-marital relations. No one has
ever formulated a general sexual standard which could be safely regarded
as normal. Too many individual conditions of temperament and health
enter into the proposition to permit of a standard being formulated. It
must, therefore, be regarded as an individual question to be adjusted,
if necessary, by the family physician. What may safely be regarded as
normal and harmless in one, constitutes, for many reasons, excess in
another. When a man performs hard physical or mental labor, his sexual
aptitude or capacity is limited, and this limitation cannot be exceeded
without risk. Such a limitation may not constitute an excess in a man
whose occupation does not call for a great expenditure of physical or
mental energy. Any indulgence which produces exhaustion is excessive.

The age of the individual has undoubtedly much to do with his sexual
endurance. A young, virile adult will tolerate a sexual expenditure
which would seriously affect the health and vigor of an older man.

Environment and inclination are factors in determining the standard of
some people. If the marital relations are participated in simply to
preserve peace and harmony in the home, they are productive of harm even
if indulged in moderately.

The symptoms of sexual excess are much the same as those of self-abuse.
To a certain extent, however, they are favorably influenced, because the
conditions under which the relationship is practiced are natural,
because the participants are matured physically, and because there is no
element of worry over the probable effects.

Sexual excess defeats its own purpose, because it engenders a lack of
desire and consequently it is to a certain extent a self-limiting
process. We must also remember that excess entails consequences just as
the breaking of any natural law is followed by retribution of some kind.
In these cases we find that discomfort follows excess. The parts become
irritated and congested and disease of the prostate gland always
follows.

TREATMENT.--Stop the excess by self-control and self-restraint. Employ
all the aids dictated by an intelligent perusal of the laws of sex
hygiene. Preserve the general health. It may be necessary to resort to
local treatment, because, if the parts have been abused by excessive
indulgence, there is always more or less irritation and congestion
present. This condition affects the nerves, suggestive reflex sensations
are produced by a congested prostate and the patient becomes morbid. It
is essential for such patients to consult a physician whose local
treatment will stop the sensitiveness in the parts and relieve him so
that he may carry out his programme of restoration unhampered by
conditions which are only amenable to local treatment.

WHAT PARENTS SHOULD KNOW ABOUT THE SO-CALLED "SOCIAL EVIL" BEFORE
SPEAKING WITH AUTHORITY TO "THE BOY."--To be qualified to speak with
authority, or convincingly, to a boy upon sex hygiene, the parents must
be familiar with, and well versed in the subject. The facts related in
the preceding pages must be thoroughly understood. No parent can study
these facts intelligently without being impressed with the importance of
the subject; without realizing that it is absolutely essential that the
fundamental principles of sex hygiene should be taught to the rising
generation; without acknowledging the tremendous part for evil which
prudery and ignorance play in the education of youth; and without being
convinced that most of the evil is the product of ignorance on the part
of the boy, and that parents are in a large sense to blame if they fail
to impart the necessary knowledge in time.

The need for enlightenment in sexual matters is a product of existing
conditions. Civilization and the social environment are developing along
a plane which subjects the youth to temptations that practically did not
exist in the past. There is a broader and looser code of ethics.
Business monopolizes the entire time of the father, and social and
political unrest and misdirected ambition distracts the mother. The son
or daughter has a wider latitude and a freer reign than they once had.
The opportunities for promiscuous intimacies are easier, and the public
conveniences and utilities lend themselves to the designs of
evil-intentioned and loose-moraled women. The ease of travel, the laxity
of laws, the theater, with its unchaste and indecent plays, the moving
picture snows, the vaudeville resorts, whose highest priced "talent" is
some voluptuous female, who has cultivated the art of draping nudity
with suggestiveness and singing immoral songs, all tend to give youth a
false impression of the reality of life and to make the path of the
degenerate easy and profitable. The rich are growing richer, and their
children are pampered and overfed and underrestrained. Time hangs
heavily on their hands and their only mental effort is to devise new
methods and new ways of satisfying the lust of liberty and
overstimulated desire. The poor are growing poorer, and to "keep in the
ring," to live and dress beyond their means as many do, it is necessary
to have an unexacting standard of morals. In this way the promiscuous
libertine is evolved,--the most insidious and dangerous product of
present day civilization, and the most pernicious factor in the spread
of immoral impulses and indecent diseases.

Parents must accept these institutions and agencies as necessary
instruments of evil and adopt measures to nullify their attractiveness.
Eternal vigilance is the price of success, but the quality of the
vigilance must be dictated by love, not by suspicion and distrust.

When the parent can convince the boy that the knowledge is imparted, not
with the intention of depriving him of what he may construe as his
natural liberties and rights, but with the single intention of adding to
the sum total of his pleasure and success, he will look more kindly upon
any proposition that suggests a course of conduct that leads to clean
living. Sex hygiene will eventually find a natural place in the scheme
of education. It will be taught to male and female alike. In the
meantime, however, we must begin by educating the educators--the
parents. In the beginning, their task will not be easy. There will be
much to overcome, much ignorance, prudery, false modesty, hypocrisy;
there will be much vicious teaching and evil example to live down. But
we cannot hope to achieve results in the noblest cause, save by patient,
intelligent, and persistent effort and by self-sacrifice and a constant
enthusiasm. The aim is to tell all,--all the truth,--so that we may
never be assailed by the cry, "No one told me, I did not know," from the
loved lips of son or daughter gone astray.

THE FATHER AND THE BOY.--The right kind of father can always find the
time and the way to awaken in the heart of the boy the spirit of
companionship. No boy living will resent the fellowship of the right
kind of father. It depends upon the father! If the spirit of chumminess
does not exist between you and your boy, you are at fault, you have made
a mistake, you have missed your opportunity, you "did not go about it in
the right way and in the right spirit." Try again--it may not be too
late.

The father who adopts the habit of taking his boys (and his girls too)
out for long walks, at least every Sunday, and who spends an hour with
them every evening--is the right kind of father. One who has never
tested the merit of walks with children cannot possibly appreciate the
enjoyment and benefit that can accrue from them. It is not only the
physical good that results, nor the inspiration which one may draw from
nature, but the concrete advantages that come from the fellowship with
the children are a new and a real experience--this is what counts. You
will have opportunities of sewing seeds in their minds that will grow
into a harvest that will astonish you. Children in the right mood--and
they are in the right mood when they are happy, and they are happy out
in the open with an interesting companion--are alert, and responsive,
and eager to be told "things," and this mood can be put to marvelous use
by the "right kind of father." The father who wanders forth with the
fixed purpose of thinking out some business problem during the walk and
permits the children to find their own amusement is the wrong kind of
father. He must choose to be a child again, he must desire to please
them, he must make an effort to be in harmony with them, he must draw on
his experience to interest them, he must talk to them entertainingly of
every interesting problem which the walk itself suggests or he must
formulate a plan and select a subject with a definite educational scheme
in view. We can, in a most effective way, begin to build their
characters, and, by the right kind of talk and enthusiasm, he can
determine their resolves to be honest, truthful, just, clean,
sympathetic. He can instill into them, in a thousand different ways, the
determination and inspiration to succeed. It is a wonderful and a
precious chance, and it will make the "right kind of father" more just,
more sympathetic, more optimistic, and it will make him young again and
more successful. Try it.

Implant in the hearts of your children a love of home, make the evening
meal and hour by the fireside a period of congenial fellowship, when all
the little irritable ruffles of the day may be ironed out and swept
away. The secret is to be intimate. Tell them the secret of success from
your standpoint, how happiness is gained only by being efficient and
successful, and that, to be efficient, one must be energetic and
healthy. Drum into their ears the truth that life is a battle, and only
the brave "win out," and health is the one essential necessity. It is
astonishing how such talks will impress young minds. They will remind
you of things you said, that made a lasting impression on them, long
after you have forgotten the incident.

A father can, in this way, by talking of the future to his boy, convey
to him the high hopes he entertains of the great success the boy is
going to achieve--you establish a standard in the boy's mind, and he
unconsciously hopes to attain that standard. If you have impressed him
with the necessity of preserving his health and strength, as an
essential to success, he will be slow to yield to any temptation that
may interfere with his plans. This reasoning may sound quixotic to some
people, but it is the truth. Many a boy has been inspired to success by
the knowledge that his mother or father believed in him, and was
confident he would be a leader. He strove to justify the pride and
confidence of those who held him dear, and he won out.

To retain his health, therefore, is the first impulse to be conveyed to
the boy. When he recognizes this truth, it is an easy task to instill a
love of exercise, gymnastics, swimming, fresh air, cleanliness and
temperance in him. If these are attained, you will have tided him over
the tendency to self-abuse, and you will have rendered him less likely
to yield to evil suggestion or temptation. His confidence in you will be
whole-hearted and implicit. You can do anything with him at the
psychological moment. It is now time to talk of more intimate matters.
Carefully and tactfully, the father approaches the fundamental truths of
sex hygiene.

The selection of a subject for a text as a means from which to advance
toward the real facts is sometimes of importance. It must not appear as
though the subject was designedly chosen. If it follows in a natural way
it will more thoroughly interest the boy and he will have swallowed a
large dose of truth before he is impressed with the personal viewpoint.
A passing trotting horse has served me a number of times for intimate
talks with boys on heredity and kindred subjects. I invite the boy to
watch how the horse uses his legs, and how rhythmically and beautifully
he places his feet, and how his whole attitude serves the end for which
he is exerting himself--to gain speed. Tell the boy the story of how
professional breeders have achieved such marvelous results; how for
generations the "strain" has been kept clean and pure, how any
descendant of a great sire, who showed any habit detrimental to the
development of the highest racing qualities--no matter how trivial the
disability might be--was cast aside, experience having taught that it
does not pay to waste effort and time on any horse whose physical or
mental characteristics are not up to the highest standard. Such a horse
will not win, and it is only "wins" that count.

Change the subject to human beings. Tell him how the race maintains its
standard; but show him the difference between the methods employed. How
the horse has his mate selected because of the female's good qualities,
so that the offspring may possess like qualities, if not better, and
that the selection is made by men who know their business, and have had
long experience in the work. How, on the other hand, a young man with no
experience is permitted to choose any woman he may fancy irrespective of
her qualifications. As a consequence, we have all kinds of children,
good and bad, feeble and strong, honest and dishonest, some degenerates
from birth, some criminal, and many diseased and inefficient, few of
them "winners." It is an easy matter to preach a little sermon from this
text. Show him how essential it is to select the mother of one's
children wisely, to know if there is disease in the future wife's blood,
if her family history is good, if her temperament is suited to his, if
her domestic qualities are satisfactory, if her principles are moral
and normal, and if she understands and appreciates the true object and
function of marriage. Show him also the element of justice involved in
the marriage contract; that he must give what he exacts, that if he
expects a healthy and normal wife, he must be healthy and normal
himself; if he expects purity and cleanliness he must give purity and
cleanliness; if he expects to mate with a fit female he must be an
efficient and fit male. Remember that every act, deed, thought, and
aspiration is regulated by laws which one cannot fool with, or disobey,
without reaping a harvest which will conquer, crush and ruin you, no
matter how clever or smart you may think yourself.

Show him the wisdom of the breeders' habit of never permitting sexual
liberties in a too young stallion. For the same reason the boy must
conserve his strength and virility for the marriage state and for the
function of procreation.

In a further talk, the father may extend this subject and gradually lead
up to the "consequences" of the unclean life. The boy will be ready for
this talk and will evince an interest in it that will be encouraging and
promising.

The talk about the science of mating the horses he will understand
readily and thoroughly, and he will not fail to see the point when you
switch to man and apply the same principles. Then when you show how
mismating is responsible for poor children quality and how disease
accounts for feeble-minded and degenerate offspring, he will be fairly
well posted, and he will be ready to imbibe more details, and you will
have done much of your duty. His curiosity will be quickened and his
interest is awakened. It depends upon the father. If your boy is honest
and clean, open and decent, he will not fall without a fight, and while
he is fighting he is maturing. If your picture of the consequences of
the venereal diseases has been effective and vivid, he will grow up with
a healthy horror of them. If your conduct as a father has been wise and
exemplary, and if your home has the right kind of environment, and the
right kind of mother in it, you have done all a father can do to help
the boy over the rough spots. The proper kind of encouragement and the
right kind of vigilance, and books which will satisfy the boy's craving
for more knowledge along this line is all that is needed to help the boy
to "win out."

FAKE MEDICAL TREATMENT FOR VENEREAL DISEASES.--Parents should in every
possible way discourage the use of patent medicines and fake medical
methods of curing these diseases. Untold harm has been done to boys and
to women by these nostrums.

In every instance the motive underlying the methods of people selling
these things is to frighten the patients into the belief that their
condition is more serious than it is in order to justify a long and
expensive course of treatment.

Their work is carelessly performed, and frequently they are directly
responsible for the development of complication and dangerous sequelæ.
The promises of speedy cures are false, and, not infrequently, methods
of black-mailing have been known to follow an expensive and unsuccessful
course of treatment.

There is no class of disease in which the help and honesty of the
legitimate medical profession is needed more than in the treatment of
the venereal diseases. Parents should see to it that the family
physician is prescribing any strange medicine that may appear in the
boy's room, and not some unknown individual who may be an impostor and a
blackmailer.

SOWING WILD OATS.--Writers of fiction and others of a more serious trend
of thought have recognized the sowing of wild oats as an institution
which, if it does not merit the full approval of society's moral code,
is, at least, tolerated. No serious consequences befall the offender. On
the contrary, the libertine is the type of hero who receives the
commendatory quips of erotic dames and the questionable interest of
hysterical maidens.

Women of easy morals are always willing to espouse the cause of the
"black sheep," and to further the matrimonial success of the penitent
_roué_. Many mothers are willing to marry their daughters to the
polished villain of society, who is known as a rake and debauchee, if
his family connections are desirable. It has been even held that a
youth who did not "sow his wild oats" was of doubtful stamina.

That many able men have sown wild oats is indisputable, and that many
men who are respectful husbands, have also gone "through the mill" is
also true, but this need not blind us to the fact that thousands upon
thousands, who could have been successful men of affairs and creditable
husbands and fathers, have been utterly ruined, as a result of having
sown wild oats. No man is a better man because of a past record of
licentious habits. The man who sows and escapes the harvest is lucky.
The man who reaps, reaps in abundance. Most men regret the lapses of
youth. Most of these lapses would never have occurred if the impulse
could have been governed by the reasoning of maturity. These acts are
the promptings of an impetuosity which may be entirely foreign to the
individual's innate character, but brought out by promiscuous
circumstances and the ignorance and license of youth. If we can protect
youth, by an adequate knowledge of the consequences, we will furnish the
means to tide over the impressionable period. Until a healthy maturity
of judgment will assume the task unaided.

The effects of the wild oats' theory are too tragically evident to need
any argumentative refutation. The statistics of the prevalency of
venereal diseases alone is sufficient; the results of these diseases are
more than enough.

Study the records of the jails and prisons, courts and asylums,
hospitals and health resorts, think of the hundreds of thousands of
diseased and deformed and mentally inferior children, of the multitude
of paretics, melancholies, ataxics, maniacs, syphilitics,--all the
products of "wild oats,"--and ask if the wild oats' theory is
justifiable.

Think of the ruined homes, the wretched lives of fallen women, the
hopeless prayers of abandoned wives, the loneliness and misery of
parents neglected and forgotten, the "bastards" and fatherless children,
the drunkards and criminals and tramps--all weeds of the wild oats'
harvest.

Then reflect upon the tragedies, the suicides of the betrayed and of the
diseased, the bank thief, the broken hearts of deserted and hungry
children, the army of inefficients--around whose necks hang wild oats'
medals, the men of big business, who constantly fight the effects of
early incontinence and abuse, and the thousands who go to early graves,
and then ask, in all justice, if the sowing of wild oats needs
justification.

Who supports the thousands of prostitutes? Who made them? Wherever you
find pauperism, crime, drunkenness, insanity, idleness, immorality, vice
and disease, you will find that the sower of wild oats has traveled the
path and left his stain and his footprints there.

SHOULD CIRCUMCISION BE ADVISED?--The answer to the above question is
"Yes," in every instance. If circumcision is done early,--during the
first two weeks of life,--the operation is without danger and
practically without pain. In quite a considerable percentage of all
males, circumcision is an absolute necessity. For excellent medical
reasons, about which your family physician can inform you, every boy
should be circumcised.




CHAPTER XIV

A MOTHER'S DUTY TO HER DAUGHTER

     What a Mother Should Tell Her Little Girl--Where Do Babies Come
     From--How Baby Birds and Fish Come from Eggs--How Other Animals
     Have Little Nests of Their Own--The Duty of Mothers to Instruct
     and Direct--What a Mother Should Tell Her Daughter--Every
     Mother Should Regard This Duty as Sacred--Every Female Child is
     a Possible Future Mother--Motherhood the Highest Function of
     the Sex--Health the One Necessary Essential--Symptoms of the
     First, or Beginning Menstruation--The Period of Puberty in the
     Female--Changes in the Reproductive Organs at Puberty--The
     Female Generative Organs--The Function of the Reproductive
     Organs--The Age of Puberty in the Female--The Function of the
     Ovary--The Function of the Womb--Why Menstruation Occurs Every
     Twenty-eight Days--The Male or Papa Egg--The Function of the
     Spermatozoa--"Tell the Whole Story"--"How do These Spermatozoa
     Get There"--The Union of the Species--"How Can a Baby Live in
     There for Such a Long Time"--How the Baby Gets its Nourishment
     in the Womb--Girls Must Not Become Mothers.


WHAT A MOTHER SHOULD TELL HER LITTLE GIRL.--Every little girl should be
told the Story of Life by her mother. It should be told in simple
language, so that the little girl will understand. Very early in life
the little girl will be prompted to inquire of her mother "Where do
babies come from?" It is wrong to give an evasive reply to this natural
inquiry or to postpone telling the story, because they will be told it
by playmates and will receive very wrong and very crude impressions of
this wonderful subject.

Every mother knows enough of life to tell her little girl its story in a
way that will impress her with the sacredness of God's beautiful
reproductive plan. She should begin by telling her a story about how the
birds live. How at a certain season of the year they choose a mate and
go housekeeping. They build a nest, and when it is all nicely finished,
the mother bird lays her eggs. Then the papa and mamma bird take turns
and sit on the eggs to keep them warm, and after a time the egg breaks
and a little bird is born into the world. They feed the little baby
birds until their feathers grow, and when they are old enough they fly
away from their home and begin life by themselves.

Many questions will be asked as the mother tells the story in her own
words, and the correct answers to these questions will fill in all the
difficult-to-understand points. The story of how the fish lay eggs in
shallow water so that the sun may keep them warm and hatch them out will
interest also. Be careful to impress upon them that there is always a
mamma and a papa, a male and a female bird and fish,--that this is
necessary because God made it so, and we must obey His wish. When the
little girl fully understands the story of the egg bird, and egg fish,
the mother can tell how the Creator thought out a different plan for
other animals like the dog, horse, lion, elephant, and cow. He knew that
it would neither be safe nor possible for these animals to stay at home
long enough to sit on eggs and hatch their babies, so he made a nest for
them inside of their bodies. There they would be warm and would always
be with their mammas no matter what they were doing. So we come to the
answer to their question: "Where do babies come from?"

These interesting stories, according to the intelligence and sincerity
of the mother, can be taken advantage of, to impress the little girl
with the importance of many of the lessons of life. For example, her
attention can be drawn to the fact that man and woman are the highest
types of living things that God made. No other living thing, animal, or
fish, or bird, or tree, or flower, can talk, and think, and reason as
man and woman can. Because of this faculty--to think and reason--the
human family are always trying to find out what can be done with all the
other things God made. We try to find out what the different rocks are
good for; what the different trees are good for, and the different kinds
of earth, and animals, and birds, and fishes, and everything in the
world. We study these, and we learn much, and we are made happier and
more comfortable by what we learn. For example, by studying horses, and
feeding and breeding them carefully, and training them, and caring for
them, we can make stronger horses and better and faster horses; by
studying trees, and planting them in soil best suited to them, and
giving them plenty of water to drink, we can compel these trees to grow
better apples and pears and peaches. In the same way we can produce
better strawberries, and oranges, and grapes, and we can grow flowers
with sweeter smells and prettier colors. We do all this by training
these animals and trees to grow a certain way, to eat certain food, to
drink pure water, and we protect them from the cold and sometimes from
the sun if it is too hot. Our faculty to think and reason has taught us
just what is good for them, and we compel them to obey our laws. As a
result they become strong and more healthy. Now show the little girl how
important she is; how much more precious she is than a tree, or animal,
or flower, and how much more necessary it is that we, mammas and papas,
should use our ability to think and reason in her interest. Show her how
we have found out all about babies and little girls and how we know just
what to do to make strong and healthy, and pure, and good, and clean men
and women of all the little boys and girls in the world. Tell her that
this is what mother is doing now, training her and compelling her to do
the things that will make her a strong and a good mother when she grows
older. Let her distinctly understand that it is the duty of mothers to
instruct and to correct their little daughters when they do any wrong.
Mothers know, because they have had experience in these matters, and
they know just how a little girl must live, and dress, and eat, and
behave, in order to be strong and pure, and good. So when mother
reproves and corrects, it is because she knows that what you are doing
to merit a correction is not for your ultimate good. Show them that all
young things, and young animals, and young babies, and young girls, must
be compelled to obey certain rules and laws, otherwise they would not
grow up to be strong and healthy. Sometimes a rose bush grows up among
stones and weeds, but it never thrives, it is always more or less sick.
It does not grow strong, its flowers are poor little sickly things
compared to the roses on a bush that is planted in proper soil, and
carefully tended and pruned, and watered. So would the little girl turn
out if she grew up in bad company and did not have a mother to guard and
guide her,--to prune her when she was growing careless. Everything in
this world has a meaning, and when mother tells you that you must not do
a certain thing you very much want to do, she has a very good reason for
telling you not to do it. You may not know the reason, but you should
have confidence in your mother, you should believe that she knows what
is best, and that she would not inflict pain or cause you suffering
unless she knew it was for your good. The young horse does not
understand why a halter is put around its neck and is made to run around
in a circle until it is tired. It would much rather enjoy itself in its
own care-free, and happy way. And when finally a full set of harness is
put on, and it is put into the shafts of a wagon and tied there, and
made to pull it and its driver many weary miles the horse does not like
it, and he rebels strenuously. He is, however, compelled to obey in the
end, and he finally consents to become a useful horse.

It is exactly the same way with every little boy and girl. We are put
into this world for a certain purpose, and we must all work. Now parents
know this, and they know just how to prepare little girls and boys for
this work. They therefore ask them to do many things that are not
pleasant or agreeable but which must be done in order to prepare them
for the work ahead.


WHAT A MOTHER SHOULD TELL HER DAUGHTER

Your daughter is now about fourteen years of age. She is about to pass
from girlhood to womanhood and she should know more of life's story. The
mother will now tell her the complete story in the form of little talks,
based upon the following facts as texts. Each mother will doubtless add
to the story as conditions justify and as the education of the mother
and daughter may dictate. A multitude of little side talks can be wisely
indulged in to make clear any uncertain or doubtful explanation, and
every one of these incidental excursions can be made exceedingly
interesting if wisely and opportunely chosen. Always remember, however,
to emphasize the sacredness of the story. Do not permit your daughter to
get the impression that you are telling her something that simply has to
be told, just as you told her the correct way to boil an egg. Let her
realize and get the impression that this is the most serious and most
wonderfully interesting story in existence, the most important story she
will ever hear. Let her understand that motherhood, for which she is now
preparing, is the duty God assigned her in this world: that that duty
must be carried out, and that she must do nothing, nor leave anything
undone, to interfere with its accomplishment. Do not only impress her
with the story itself, but let your own explanation be so emphatically
serious, that she will deeply appreciate its momentous significance--an
occasion to be remembered all her life.

If she gets the proper impression from you at this time she will never
treat the subject lightly, or permit it to be promiscuously discussed
within her hearing.

Begin by telling her that she is about to enter the most important
period of her life. Explain why this is so in the following way, in your
own words. If we admit every female child to be a future mother, and
motherhood the highest function possible to the sex, then the awakening
of the sex organs and the mother instinct, must be the most important
developmental episode in the life story of every woman. If this is so,
then it follows that every girl should enter this period in the very
best physical health possible, in order to reap the best results
incident to this evolutionary period. We impress and warn her,
therefore, that, as her system is about to undergo important changes,
she must be particularly careful of her health. A little mistake at this
time may be followed by more serious consequences than if made at any
other time in her life. If a girl is to become a mother, certain changes
must occur in her body before the nest, of which we previously wrote,
can be made ready. God did not overlook anything when He peopled the
earth; He therefore wisely planned that these changes in the female
should occur at a time when the girl is strong and healthy.

THE PERIOD OF PUBERTY IN THE FEMALE. SYMPTOMS OF BEGINNING
MENSTRUATION.--At about the age of fourteen these changes begin to give
evidence of existence. They affect the girl's whole system and the
mother must be especially patient and sympathetic. Her disposition may
change, she may want to be alone, and she may be more or less
melancholy. She will be dissatisfied with the things that previously
interested her. She will tire easily, and she may have many spasmodic
pains from time to time. The wise mother will tactfully see that she
takes plenty of nourishing food and systematic exercise, and that she
gets enough sleep in a well-aired room. There are other physical changes
which are observable at this age. The girl grows taller, the figure
broadens out, the hips widen, the bust enlarges, and the waist line
increases in size. These are all part of the great change from girlhood
to womanhood.

CHANGES IN THE REPRODUCTIVE ORGANS.--The principal change takes place in
the reproductive organs themselves, and it is very essential that she
should have a clear mental picture of just what is meant by
"reproductive" organs and their location in her body. We mean by this
term the group of organs which are concerned in creating and nourishing
a child until it is old enough to be born into the world.

THE FEMALE GENERATIVE ORGANS.--These organs are the womb or uterus, two
ovaries, two fallopian tubes and the vagina. The womb or uterus is the
"nest." It is about the size of and is shaped like a pear. It is hollow,
however, though its walls are quite thick. The ovaries are about the
size of a peach stone and lie at the side of the womb,--one on either
side. The fallopian tubes connect the ovaries with the womb. The vagina
connects the womb with the outside world,--it is sometimes known as the
birth canal. In the very lowest part of the abdomen, or belly, in front,
is the bladder, which collects the urine until it is necessary to pass
it out. In the back part of this region is the rectum; it collects all
the undigested food, etc., from the intestinal canal. Between these
two,--the bladder and rectum,--we find the reproductive organs, the
womb, ovaries and vagina, described above.

THE FUNCTION OF THE REPRODUCTIVE ORGANS.--It will be difficult, even for
mothers, to acquire a clear understanding of the function of the
reproductive or generative organs. It is an exceedingly interesting
process, however, and it is well worth a patient, attentive study to
clearly understand the brief description we give of it. If you acquire a
distinct mental picture of the problem you will be able to tell your
daughter a story that will be of intense interest to her, and a tale
that is interesting is impressive and is productive of thought and
reflection. That is the condition of mind we want daughters to be in
when they hear this story.

The human ovaries begin to prepare themselves for their life work when
the girl is about eight years of age. When they are ripe, or ready to
perform this duty, the girl menstruates for the first time. This is
known as the age of "puberty," which implies that she has developed,
passed from girlhood into womanhood. After having reached the age of
puberty it is possible to become a mother.

THE AGE OF PUBERTY.--There is no fixed age at which the first
menstruation takes place. Some girls develop quicker than others,--a
condition that depends upon the health and type of girl. A strong,
robust, full-blooded girl will menstruate at an earlier age, than will a
sickly anemic girl. The average age is fourteen years, though there is
no reason to worry if a girl does not menstruate for a number of years
later. In warm climates the age of puberty is from two to four years
earlier than in more temperate climates.

THE FUNCTION OF THE OVARY.--Just what takes place in each ovary when it
is ripe is best explained by likening an ovary to an orange,--though of
course the ovary is very much smaller than an orange, as was previously
noted. If you make a cut in an orange and squeeze it, you express some
of its juice and most likely you will also express one or more seeds.
The seeds of the ovaries are called "ovules," and the process by which
it expresses them is called "ovulation." Of course there is no actual
squeezing of the ovary,--the ovules grow in the ovary, and as they ripen
they come to the surface, and when actually ripe, the part of the
surface of the ovary to which they come, opens up (like a flower
unfolding when in bloom), and they fall out. The ovule we may regard as
the human female egg, and one ripens and falls out every twenty-eight
days.

When the egg falls out of the ovary it falls into the tube which carries
it into the womb. This tube you will remember is called the fallopian
tube. The ovule or egg is now in the cavity of the womb where we will
leave it for the present.

THE FUNCTION OF THE WOMB.--While these changes are going on in the
ovary, the womb is also preparing itself for its share of the work. The
lining or internal surface of the womb is composed of mucous membrane,
much the same as the interior lining of the mouth and throat. This
lining becomes congested with blood, and is so intensely swollen at the
time when the ovule or egg reaches the womb, that it is ready to rupture
and bleed all over its surface. Just whether it will rupture and bleed,
depends upon whether the egg is going to grow into a child or not. If it
is not going to grow into a child, it immediately bleeds freely, and
continues to bleed, until the whole lining of the womb and egg is passed
out into the outer world. This takes four or five days and constitutes
"menstruation." After menstruation is over, the womb begins again to
prepare itself for the coming of the next ovule or egg, and as this
occurs every twenty-eight days, menstruation is commonly termed the
"monthly periods."

WHY MENSTRUATION OCCURS EVERY TWENTY-EIGHT DAYS.--The reason why the
womb does this every twenty-eight days is because it is impossible to
tell just when the womb will be called upon to nourish and support a
child. If it did not get rid of the old blood, it would not be in a
healthy condition to nourish and take care of a baby, nor would its
interior be ready to supply new fresh blood for the growth of the
infant. Hence nature constructs and builds a new "nest" in the interior
of the womb each month. It very much resembles the new home into which
the bride and groom, go to begin housekeeping.

When you told your little girl the story of life, you particularly drew
her attention to the important fact that every living thing is created
by the union of a male and female principle, and, therefore, has a mamma
and papa. This applies to trees, flowers, vegetables, fish, animals,
birds, insects,--every living thing, including human beings. We have
seen that the ovule from the ovary is the female egg, or principle. It
is the part the female contributes toward the future child. Before a
child is possible, however, the ovule must meet the egg from the male.

THE MALE OR PAPA EGG.--The male or papa egg is called a "spermatozoa."
It reaches the interior of the womb through the lower opening, which you
will remember opens into the vagina. Emphasize to your daughter that the
female ovule or egg, and the male egg, or spermatozoa, are minute
objects, so microscopically small that a hundred million of them could
comfortably lie upon a ten-cent piece.

THE FUNCTION OF THE SPERMATOZOA.--God gave the male spermatozoa the
power to move. To watch them under the microscope you would imagine you
were looking into a bowl of water, in which there were hundreds of
little fish all squirming around. But the most wonderful thing about
them is, they can only move in an upward direction,--they seemingly
cannot move downward, or sideways. If you think for a moment you will
understand why God gave them this marvelous property. When the male
semen is deposited in the female vagina, there are thousands of these
minute, living, moving spermatozoa in it. The womb is above the vagina,
and the female egg is in the womb, consequently, to reach this egg, the
spermatozoa must travel upward. To travel in any other direction would
be fruitless energy. There is only one female egg, but there are
thousands of male eggs, or spermatozoa; it is easy, therefore, to
comprehend how one of these spermatozoa should exactly be in line with
the female egg in its upward path, since there are so many of them. It
is only necessary that one should meet the female egg in order to
impregnate it.

The shape of the male principle, or spermatozoa, is exactly like a
little tadpole, and you no doubt recall that a tadpole has a minute
tail, the movement of which enables it to swim around. So has the
spermatozoa, and by the incessant movement of this microscopic tail they
all move upward as soon as discharged by the male. I told you that God
gave the male-germ life. It is necessary now to explain the character of
this life. It is very brief; it is estimated that they are active for
two hours, and then become inactive, or die. The best way to explain the
brief activity to your daughter, is to liken the spermatozoa, to a
mechanical toy, which is wound up to go for a certain time. After it
runs out it becomes inactive; this is exactly what happens to the little
human tadpole. If during this brief life none of them has happened to
reach the female egg, pregnancy does not take place and menstruation
occurs. On the other hand, if this were not so,--if these spermatozoa
were active for a longer period, pregnancy would almost be certain to
take place every time the womb was not already occupied with a
pregnancy.

TELL THE WHOLE STORY.--When a mother reaches this stage of the wondrous
tale she will be asked by an innocent girl,--"How do these spermatozoa
get there?" or, "You have not told me where these tadpoles came from"
or, "I don't understand how these spermatozoa got into the vagina" or,
"I don't know why you call these the male egg when they are in mamma."
It does not matter how it is expressed, the intent is plain enough. I
have said, that an innocent girl will ask this question, the implication
being that one who is not innocent will refrain from asking this
question. A girl who knows the answer will not ask, because, if she is
familiar with this subject before her mother thinks it wise and proper
to tell her, she obtained her information from a source which, most
likely, insinuated a suggestive, or evil, meaning into the explanation,
consequently she would be afraid, or ashamed, to ask the question. An
innocent girl, on the other hand, would rightly ask for information
which is obviously kept back, and which she has a right to know, since
a complete, and intelligent understanding of the story depends upon the
elucidation asked. If it is proper to tell part of the story, it is
essential to tell all of it. Tell it in your own words in this way:

When God conceived the human race He ensured its perpetuation by
designing a method whereby this would be rendered possible: He did more;
He wisely decided that the function, involving the very existence of the
human race, should be attended with a sentient gratification. He further
instilled into the fundamental economy of mankind, sex attraction, which
is involuntary, undeniable, and unquenchable. If God conceived the means
and the method, no human mind in possession of its faculties should see
evil where it does not exist. It was by Him designed that the male organ
of reproduction should deposit its germinating fluid in the vagina of
the female, and this is accomplished by a union of species.

The one set of reproductive organs is a complement of the other, and
essential to the other. It is by this act that the male spermatozoa is
enabled to complete the function of fecundation.

If now we assume the male and female element to have met and united,
menstruation does not take place. The egg or embryo (the future child)
begins to grow, and it remains in the womb for two hundred and eighty
days from the day when the male and female egg met. It is quite natural
for an intelligent girl to ask her mother to explain, "How a baby can
live in there for such a long time," or "What makes it grow if it does
not get anything to eat or drink."

HOW THE BABY GETS ITS NOURISHMENT IN THE WOMB.--These questions can be
answered in this way. While the baby is in its little comfortable home
it gets everything it needs. You are in your home now. If you wanted a
drink, what would you do? Wouldn't you go to the water faucet and draw a
glass of water? The water comes to you through a pipe, right into your
home, you don't have to go out of the house to get it. And if you wanted
light when it is dark you would turn on the gas and light it. It, too,
comes into your home through a pipe. Now baby gets its air; and food,
and all it needs to drink in just that way. There are two little pipes
which go into its nest or home, and then into the baby's body at the
navel, and through these pipes fresh blood runs in and out. When mother
breathes, her blood sucks up oxygen from the air in her lungs, and the
blood carries oxygen to every part of her body. In this way, all parts
are supplied with the proper quantity of air. Now the baby is simply a
new part of mamma as long as it is in its nest in her body, so it too
gets air in this way. When mother eats, the food is taken into her
stomach and it is there changed into liquid and so prepared, that when
it passes into the intestines, the part of the food that is good for
her, is sucked up into the blood, and the blood carries it to every part
of her body. It distributes whatever is needed to all parts, and as the
baby is a part, it gets its share. The other pipe carries the blood back
again, out of the baby for new supplies, and as this is going on all the
time, there is no danger of the baby starving in any way, or at any
time.

When your daughter understands this, show her how important it is that
mothers should be in good health, otherwise the baby will not get good
food, it will not be properly nourished and will be born a poor, little
sickly child. Little girls, consequently, should try to eat properly,
exercise regularly, and do everything their mothers tell them, so that
when they become mothers, they will be able to nourish their babies and
not bring into the world poor little starved infants.

GIRLS MUST NOT BECOME MOTHERS.--We have previously stated that girls can
become mothers when they have reached the age of puberty. God did not
intend, however, that girls at the age of twelve or fourteen should
become mothers, because their bodies are not strong enough, nor are they
fully grown, nor have they the experience, to undertake the physical
task and responsibility of bringing a baby into the world. We know this
from experience, because we have seen the sickly babies such girls have,
and we have seen how much these girl mothers suffer, and how they ruin
their health, by trying to do what God did not intend they should do.
Even the trees teach us this lesson. An orange tree will bring out buds,
which would develop into oranges, when it is two years old. The
experienced farmer, however, will pluck these buds off, and will do so
every year, till the tree is five years old. If he allowed the tree to
bear fruit during its young years, the oranges would not be good, or
sweet, or large; so he waits until the tree has grown and is strong and
healthy, when its fruit will be large and sweet. An orange tree of this
type will have better fruit, and will continue to produce this good
variety for many years. A tree allowed to bear fruit when two years old
will never have first class oranges, nor will it continue to have, even
poor oranges, as long as the other.




CHAPTER XV

PREPARING FOR MOTHERHOOD

     Menstruation--Irregular Menstruation--Changes in the Quantity
     of the Flow--How the Womb is Held in Place--Symptoms of
     Menstruation--Menstruation Should Not be Accompanied with
     Pain--Don't Give Your Daughters Patent Medicines or "Female
     Regulators"--Take Your Daughter to the Doctor--Leucorrhea in
     Girls--Bathing when Menstruating--Constipation and Displaced
     Wombs--Dress and Menstruation--Absence of Menstruation, or
     Amenorrhea--Treatment of Amenorrhea--Painful Menstruation, or
     Dysmenorrhea--Causes of Dysmenorrhea--Treatment of
     Dysmenorrhea--Sterility in the Female--Conditions Which Affect
     the Fertility of Women--Climate--Station in Life--Season of the
     Year--Age--The Tendency to Miscarry--Causes of Sterility in the
     Female--Displacement of Womb--Diseases of Womb, Ovaries, or
     Tubes--Malformations--Lacerations--Tumors--Leucorrhea--Physical
     Debility--Obesity--Special Poisons--"Knack of
     Miscarrying"--Miscarriage--Cause of Miscarriage--The Course and
     Symptoms of Miscarriage--What to do when a Miscarriage is
     Threatened--Treatment of Threatened Miscarriage--Treatment of
     Inevitable Miscarriage--After Treatment of Miscarriage--The
     Tendency to Miscarriage.


MENSTRUATION

We have explained in the previous chapter what menstruation is, its
frequency, its significance and its origin. There are a number of its
common characteristics with which the mother and daughter should be
acquainted.

IRREGULAR MENSTRUATION.--Menstruation may occur once (the first time)
and fail to recur the following month or for a number of months. This
need cause no alarm as long as the general health remains good. It will
come again in its own time. Nervousness may cause a suspension of
menstruation. This is quite common in school girls who are driven too
hard at school, whose sleep is interfered with, whose appetite is poor
and who are allowed too many social indiscretions, as parties, dances,
etc., where late hours are observed, all of which should be put aside
until school life is over. Sometimes menstruation will temporarily stop
if the girl goes away from home on a visit.

Sometimes the quantity will be greater than at other times, and a very
scant flow, after it has been free and regular may cause apprehension.
Various causes may be responsible for a decrease, catching cold, sitting
on cold steps or cold ground, wearing damp clothes, nervousness, mental
worry, physical exhaustion, insufficient food and exercise, and anemia,
may cause it. For these reasons a girl should be exceedingly careful of
her health, she should guard against catching cold. Do not change the
underwear until certain that the weather is far enough advanced in
season to justify such a change. She should not become exhausted or
worry. In all cases of suppression, or of increased flow, a physician
should be consulted at once, and girls should be instructed to tell
their mothers of any change in the character of the "periods," as soon
as it occurs. Mothers should instruct their daughters to rest the first
day of their monthly flow, and all during the menstruation they should
refrain from any unusual activity. Even play should be moderated and
abstained from entirely if there is any pain. In order that the girl
fully appreciates why these rules are laid down, it is advisable to
explain just how the womb is held in place in her body.

This appears to the writer as being a particular important point. A girl
must not be expected to give these matters the serious consideration
they merit unless she thoroughly understands the reasons why. An
explanation, in the form of even an intelligent talk, will soon be
forgotten. If, however, a definite, concrete picture, is impressed upon
her; if she actually sees in her mind the process that is going on, she
will understand why it is necessary to do as she is told. If the mother
will therefore assure herself that the daughter actually knows what is
being accomplished in her womb at the menstrual period, she will carry
out the instructions more faithfully.

HOW THE WOMB IS HELD IN PLACE.--The human uterus, or womb, is held in
its proper place in much the same way as a clothes pin sits on a clothes
line. The heavier part is the upper part, and that part is held in place
partly by resting on the rectum behind, and the bladder in front. When
menstruation occurs, the body of the womb becomes much heavier because
of the increased amount of blood in its interior. This added weight
increases its liability to tip over, and if any extra strain or effort
is made at this time it will become tipped, or as the physician calls
it, displaced. If a womb becomes displaced, every menstruation afterward
will be painful and prolonged,--sometimes excessively so. A displaced
womb becomes congested and unhealthy. It causes leucorrhea or a chronic
discharge, makes a nervous wreck of the woman, results in sterility and
frequently in a dangerous operation. There are, therefore, ample reasons
for watchfulness and care on the part of the growing girl.

SYMPTOMS OF MENSTRUATION.--After menstruation is established there
should be no actual pain at each period. There are, however, certain
undefined feelings,--premonitory symptoms,--which may be explained in
the following terms:--A day or two before the date on which the
menstruation is expected, the girl will appreciate that "her sickness"
is coming. She will not, or should not, complain of pain, but will state
that she has a bearing down feeling, is a little more nervous than
usual, has no desire to go into company, and wants to be more or less
her own entertainer. The "sick" period usually lasts four or five days.
The second day is the most important.

MENSTRUATION SHOULD NOT BE ACCOMPANIED WITH PAIN.--If any actual pain
accompanies menstruation, either before or after it is established, the
mother should at once take the daughter to the family physician.
Menstruation is a natural, physiological act and should not be
accompanied with actual distress or pain. It is astonishing how many
mothers will allow their daughters to suffer needlessly, for months and
years, because of the mistaken idea that "since the pain is there, it
must be," or because she--the mother--suffered, so also must the
daughter suffer. There is no more unfortunate mistake, and many a girl's
health and happiness has been blasted because of this misbelief. The
cause of the pain is, in a vast majority of the cases, a very simple
one, and can be removed in a very brief time.

Should the menstrual period last too long, be too frequent, or be in any
way not what it should be, consult your physician. If you are not sure
of "what it should be," or if you have any doubt, ask your doctor. Don't
let any false pride or feeling of modesty on your part, or on the part
of your daughter, dictate your policy under such circumstances. Don't
take the advice of your friends or neighbors in a matter so vital. It is
too important, and they are not qualified to "guess" any more than you
are. Don't, if you have any respect for yourself, or love for your
child, begin dosing her with the advertised patent medicines and "Female
Regulators" for which so much is claimed, and which seem to "just suit"
your daughter's case at this particular time. Take her to the doctor,
whose advice you value (or you should not have him as a family
physician), who has no interest at stake except to help you and your
child, and whose fee is no more than the price of one of these bottles
of advertised poison. He is the only one qualified to speak with
authority on such a momentous subject, and you will never spend a dollar
to better advantage. Warn your daughter not to speak about "her
sickness" to other girls.

Especial attention should be paid to cleanliness during this period. The
mistaken idea that bathing of any kind at this time may have disastrous
consequences is responsible for much of this neglect. If proper care is
taken warm sponge baths, in a warm room, will not cause any trouble.
Unpleasant odors can be avoided by sponging the parts with a warm
solution, into which a mild antiseptic is put, upon changing the cloths.

LEUCORRHEA IN GIRLS.--It has been stated above that a displaced womb may
cause leucorrhea or a discharge. It must be remembered that leucorrhea,
or "whites," may occur in girls as well as in married women. It can also
result from catching cold during the menstrual period. Another mistaken
idea is that girls should not take douches for fear of injuring the
hymen. This is erroneous, and while they are entirely unnecessary in a
vast majority of cases it is sometimes absolutely essential to douche in
order to cure leucorrhea. When they are given, it is advisable to use
the small nozzle that comes with every douche bag set.

CONSTIPATION AND DISPLACED WOMBS.--When the picture is fresh in the mind
of the girl, of how the womb is held upright in her body, the mother
should speak to her about the serious results that may occur from
constipation. If the rectum is full of hardened feces the womb will be
pushed out of place, and if under these circumstances straining is
necessary to empty the bowel, and if this condition is habitual,
constipation may be the actual cause of displacement of the womb.

DRESS AND MENSTRUATION.--It is also an opportune time to demonstrate to
what extent serious results may follow mistakes in dressing. The habit
of permitting growing girls to constrict the waist, to bind and pull the
abdomen by too tight garters, or too tight corset, is wrong, and no
mother should permit it. In another part of the book, this matter is
taken up more fully, but if it is explained to the girl while she is
considering the subject of menstruation, she may more quickly and more
fully appreciate its significance.

ABSENCE OF MENSTRUATION--AMENORRHEA.--The absence of menstruation after
it has been established, does not, as a rule, indicate any disease of
the womb or female sexual organs. It is to be regarded merely as a
symptom and can be, as previously stated, safely ignored if the general
health is good. If the general condition is poor, and the quantity and
quality of the blood deficient, it is a provision of nature to suppress
menstruation in the interest of the general health. For this reason it
is safe to disregard the amenorrhea and build up the bodily strength.
This explains why some girls pass the usual age of puberty and show no
signs of menstruating. They are poorly developed sexually, through
deficiency of blood. If, on the other hand, a girl should have all the
symptoms of menstruation every month, but no flow, she should be
examined by a physician to determine if there is any obstruction to the
escape of blood. Total absence of any symptoms of menstruation extending
into adult life, may indicate an absence of the sexual organs. During
the first year after puberty it is quite natural for menstruation to be
irregular; after the function is thoroughly established there are many
causes that may be responsible for its temporary absence.

CAUSES OF AMENORRHEA.--Any condition or circumstance which reduces the
general health or impoverishes the quality or quantity of the blood and
weakens the nervous system, will result in a stoppage of the monthly
periods. Among these are insufficient food and exercise, overwork,
overstudy, exposure to cold, sitting on cold steps or gold ground,
wearing damp clothes, bathing in cold water at the beginning of
menstruation, powerful emotions, as great fright, anger, anxiety; acute
diseases, such as typhoid fever, cholera, the infectious skin diseases;
chronic diseases such as Bright's disease, heart disease, consumption;
anemia and chlorosis are very common causes. Obesity or an overfat
condition will cause an early suppression of the menses which may result
in a fruitless marriage. Displacement of the womb and other local
disorders frequently result in scanty or delayed menstruation. Anxiety
lest pregnancy may occur in the newly married may cause a delay in the
periods. A radical change of climate or sometimes a visit to the
country, or changed circumstances may stop the flow for the time being.

TREATMENT.--The treatment of amenorrhea, or absence of menstruation,
will depend on the underlying cause. A careful investigation should be
made into the mode of life and the hygienic surroundings of the patient.
Her general health and her mental condition should be inquired into. If
the patient is not in good health, or is not obtaining exercise in the
open air, or if she is a victim of mental worry or of domestic
unhappiness, or if any sufficient cause exists for the amenorrhea it
must be removed before any treatment may be expected to relieve the
condition. If the patient is a married woman the possibility of
pregnancy should always be borne in mind, and no radical treatment
instituted until this has been excluded. If the absence of menstruation
is dependent upon defective development of the sexual organs we cannot
expect much from any treatment. The amenorrhea from exhaustive diseases
will usually correct itself with, or soon after, the establishment of
convalescence. In diseases which tend to death, as in consumption, heart
disease, etc., the function is never reestablished. A very common habit
of most people is to regard the absence of the monthly periods as the
cause of their ill health. It is not, it is the result of the ill
health. Get rid of the bad health and the menses will take care of
themselves. That form of amenorrhea which is the result of change of
climate or surroundings will regulate itself as soon as the victim
becomes acclimated or reconciled to the change, or returns home if the
visit is of brief duration.

As a general routine treatment, good wholesome food, regular hours,
fresh air, sunlight, and judicious exercise, with such other measures as
may be suggested by the condition of the blood and nervous system, are
the indications in the way of treatment. Anemia and chlorosis (poor
blood) should be treated by the administration of iron in some form.
Obesity should be reduced by diet, exercise, and such other treatment as
may be found efficient and not detrimental to health. Overwork, mental
and physical, should be stopped, and sedentary habits changed to a more
active out-door life. The acute suppression from exposure to cold,
wearing of damp clothes, sitting on cold stones or cold or damp ground,
sea bathing in very cold water, is very often associated with an acute
inflammation of the womb itself and calls for rest in bed, laxatives to
open the bowel, hot application to the lower part of the abdomen and a
teaspoonful of Hayden's Viburnum in a glass of hot water every four
hours until relieved. The use of the sitz bath is frequently successful
if taken at night followed by a laxative and a hot drink.

PAINFUL MENSTRUATION--DYSMENORRHEA.--Most, if not all, victims of
painful menstruation are of a nervous temperament. Dysmenorrhea is
simply one symptom of the general nervous condition. The nervousness may
be acquired or it may be the result of heredity. In girls it has been
found to be an accompaniment of the overwork and worry of school and
student life. Girls who suffer greatly from it while in school are
entirely free during vacation from school.

There is a type of painful menstruation known as neuralgic dysmenorrhea.
This is simply a local expression of a general neuralgic tendency. It
comes under conditions which favor neuralgias in other parts of the
body. Girls and women affected with this type of dysmenorrhea are often
anemic, hysterical, and not infrequently the victims of malaria,
rheumatism, or other diseases which tend to impoverish the blood and
reduce nerve vitality. The pain resembles neuralgia elsewhere. It comes
and goes, it may last a brief time or a long time, it may be very mild
or very severe. The pain bears no fixed relation to the flow, it may
proceed, accompany or follow it.

Mechanical dysmenorrhea is that form in which a mechanical impediment
exists to the escape of the menstrual fluid. The internal canal may be
too small, displacement, growths, either inside or out of the womb,
faulty development, or frequently simple congestion will act as an
obstruction and cause pain from tension. The pain accompanying
mechanical dysmenorrhea is very different from the neuralgic type. It
comes on gradually, increases slowly until it is very severe and stops
suddenly. A gush of blood from the womb announces the fact that the
obstruction has been overcome and the womb has emptied itself; as soon
as this occurs the pain ceases.

In the mechanical variety there are frequently clots in the menstrual
flow. Inasmuch as this type may be caused by imperfect development of
the womb, it is common to find that pain has characterized the monthly
periods from the time of the first menstruation. It may, however, as
stated above, be caused by growths which had their beginning at a later
period.

TREATMENT.--For the neuralgic variety the treatment should be general.
The whole object is to build up the general health. Fresh air, sunlight,
out-door exercise, plain, substantial food, regular hours, pleasant
surroundings, and such medication as may be indicated, should be the
course to follow. The bowels should be kept regular and digestion aided
in every way possible, if necessary by rest from school, or work, or by
a change of air and scene. If the patient is inclined to malaria she
must take quinine and live in a locality free from that tendency. If
rheumatic she should take the remedies advised in that disease and avoid
colds, wet clothes, or sitting in cold, badly ventilated rooms, churches
or theatres. If there are no distinct evidences of special tendencies,
general tonics may be given to advantage. These should consist chiefly
of iron, arsenic, phosphous, nux vomica, cod liver oil, etc.

The treatment of mechanical dysmenorrhea of course implies removal of
the cause. As this necessitates operative procedure, or at least an
examination by a physician, it is best left in his hands.


STERILITY

Sterility means the inability to become a parent. A woman who is sterile
cannot become a mother. She is for some reason unable to have a baby.

A childless union is frequently the cause of much unhappiness. There is
something lacking in the expression "a childless home." It seems a
paradox, as home is inherently associated with children and happiness.
It has been stated that one out of every eight marriages is barren. The
average time which elapses after marriage and the birth of the first
child is seventeen months. Physicians agree that if a woman goes over
three years after marriage without having a baby her chances of having
one are small. If children are desired, and they usually are by
childless parents, every effort should be made within the first three
years to ascertain the cause of the sterility, and if it can be
rectified. The barrenness may be dependent upon some physical defect
which will quickly respond to the proper medical treatment. It is well
to remember, however, that the defect is not always the woman's. In
every six childless marriages about one is due to sterility in the
husband. The age of the greatest fertility in women is between twenty
and twenty-four years. It is rare to find a barren woman between these
years. Nature evidently intended that the duties of maternity should be
assumed between the twenty and twenty-fourth year. If married before the
age of twenty the statistics prove that barrenness exists in one woman
in every twelve. If married after the twenty-fourth year the chances of
having children decreases with the age of the woman.

If a mother goes for three consecutive years without becoming pregnant
the chances are that she will have no more children. Consequently if
other children are desired it is unsafe to rest upon the assumption that
a woman will again be a mother simply because she has been one in the
past. Many conditions could, and may, have occurred since the last
pregnancy (and may be as a result of that pregnancy) to change her
natural fertility into a condition of temporary sterility. An
examination should therefore be made before too long an interval elapses
and the facts learned. It will usually be found in such cases that a
displacement or laceration, or at most, some cause easily remedied is
immediately responsible for the apparent barrenness.


CONDITIONS WHICH AFFECT THE FERTILITY OF WOMEN

CLIMATE.--It is a well-known fact that more children are born in
southern regions than in northern countries. It may be asserted,
therefore, that climate affects the fertility of the race.

STATION IN LIFE.--Children are more numerous among the poor than among
those who are wealthy and enjoy the luxury of riches. This condition
cannot, however, be construed as a true expression of fertile
efficiency. It is more a comparison of ethics, and when we express it
thus we are giving it its most charitable name.

SEASON OF THE YEAR.--The spring of the year, being more favorable to
fecundity, exerts an influence over the increase of population. Nursing
mothers are as a rule sterile until after weaning time. This is not
always so however, and the possibility of pregnancy taking place while
nursing a baby, and before menstruation is reestablished must be
reckoned with as it occurs quite frequently.

AGE.--Age may be said to affect the fertility of women inasmuch as
sterility is the natural and proper condition before menstruation is
established and after menstruation ceases.

THE TENDENCY TO MISCARRY.--Because a woman has never given birth to a
living child is no proof that she is sterile. Many women have the
ability to conceive but for some reason they have acquired the
misfortune, or the "knack," of miscarrying. This is a condition of the
gravest significance and will be considered at length in its proper
place.

The influence of a temporary separation has had excellent results in a
great many historical cases. Where the married couple seem to be lacking
in some one or other of the emotional or temperamental qualifications,
it is advisable to suggest a temporary separation. When this period has
expired and they resume marital relationship the element of novelty,
acting as a stimulus, quite frequently reestablishes a fertility that
was seemingly suspended, or awakens it if conception has never
previously taken place.

There are a great many cases on record where, conditions having remained
the same, women have become fertile after years of seeming barrenness.
It is impossible to explain, or to satisfactorily understand these
cases. It is quite common to note cases in which women have never become
pregnant until a number of years after marriage, even when the desire to
have children existed. There is one case on record of a woman married at
eighteen, but although both herself and her husband enjoyed habitual
good health, conception did not take place until she was forty-eight
years of age when she bore a healthy child. Women should not, therefore,
become easily discouraged in the hope of having a baby, especially when
they have a clean history, and a healthy body. The conditions may change
and may become favorable when hope is about to die.


CAUSES OF STERILITY IN WOMEN

Inasmuch as it is necessary to consult a competent physician in all
cases of sterility, it is not necessary to go into detail regarding each
possible cause, other than to explain how each may produce barrenness.
It will be observed that a competent physician is specified and advised
in these cases. This is very important because many advertising, or
"quack" doctors, particularly solicit these kind of cases. They are not
competent to be trusted with such cases and will likely effect more harm
than good. A woman should not hesitate to consult the best available
medical authority if she is a victim of sterility. There is nothing to
be ashamed of. It is a perfectly proper medical situation and should
receive the best medical advice and investigation. The following are the
more frequent causes of absolute sterility.

(A) Displacement of womb.

(B) Diseases of womb, ovaries or fallopian tubes.

(C) Malformations.

(D) Lacerations or tears of mouth of womb.

(E) Tumor.

(F) Leucorrhea.

(G) Physical debility.

(H) Special blood poisons.

(I) Great obesity.

(J) Anemia.

(K) Self-abuse.

(L) Habitual alcoholism.

(M) Lack of moderation in the marital relations.

(N) Certain diseases may be associated with barrenness: cancer,
diabetes, consumption, Bright's disease, etc.

(O) Certain temperamental conditions may be associated with barrenness:
lack of affinity, frigidity.


THE KNACK OF MISCARRYING

DISPLACEMENT OF WOMB.--In many instances the primary cause of the
displaced womb was some energetic, muscular effort, made while the
victim was yet a girl,--probably before menstruation began. Whatever act
first caused a slight tilting of the womb, must necessarily have been
an unusual physical effort, and as girls are getting more and more
strenuous we may look for more trouble in this direction in the future.
Inasmuch as a slight tilting of the womb gradually gets worse it is a
reasonable expectation to believe that sterility is a natural sequence
to displacement. The girl may have been the victim of painful
menstruation which was neglected, because not quite painful enough to
compel medical relief, which is sought for only as a last resource
unfortunately under the circumstances. Intercourse may also have been
more or less painful,--a condition which again is mistakenly and
imprudently borne in silence and left to take care of itself. But when
persistent sterility faces her, the woman seeks medical assistance and
her trouble is discovered. As the displacement is found to be the cause
of her sterility, its correction, which is a comparatively easy medical
problem, not only cures the barrenness but happily relieves her of the
menstrual distress and all other pain.

The treatment for displacement consist of placing medicated pieces of
wool or cotton, called tampons, in the vagina in such a position as to
hold the womb, _as_ nearly in its proper place as is possible. After a
time nature will so strengthen the ligaments that they will hold the
womb and a cure is, therefore, affected. The length of time necessary to
cure depends upon the length of time the displacement has existed. It
may take, from two to four months. When the displacement is of long
standing and is accompanied with more or less inflammation, adhesions
sometimes grow between the womb and the adjacent organs. It is necessary
to resort to surgery in such cases, but the result is always good and
the danger practically nothing.

DISEASE OF THE WOMB, OVARIES OR FALLOPIAN TUBES.--Disease of the womb,
ovaries, and fallopian tubes, which renders the victim sterile, is as a
rule the direct result of infection. Such infection is conveyed by the
husband to the wife. This is quite a common condition. The simple fact
that such conditions exist leads us to hope that the time is not far
distant when it will be compulsory for all participants in the marriage
ceremony to submit to a thorough physical examination. By this means,
and by this means only, will the innocent be protected. No one can
conceive, unless he has been identified, as a physician, with one of the
large metropolitan hospital clinics, of the extent of this class of
disease, and of the frightful suffering caused, and innocent lives
ruined, by infection conveyed in this way. It is a tragic corollary to
the marriage vow "for better or for worse."

If a woman is fortunate enough to fall into the hands of an honorable
physician, who will tactfully explain to her the serious significance of
her condition and obtain her consent to treat her until she is cured,
which in all probability will include a surgical operation, and will do
so with diligence, without regard to the size of the bill, she will
indeed be a lucky woman. It is from women who are suffering with such
diseases,--most of them without the slightest idea of what ails
them,--that the venders of advertised nostrums reap their fortunes, and
it is from the same victims that most of the advertised medical "quacks"
look for their blood-money. The great difficulty, however, lies in the
failure of the woman to appreciate the seriousness of her condition, and
as a consequence she fails to understands why it should take so long to
cure her. She loses confidence in her physician, she buys certain
"cures" recommended to her by Mrs. Busybody and later tries other
physicians and ends by losing faith in herself. Meantime she grows worse
and worse. There are thousands such. It may be here stated without fear
of contradiction that if the public in general would repose more
confidence in the medical profession, there would be much less
suffering, much less sorrow, fewer regrets, fewer irresponsible "isms,"
and cults, because there would be fewer disappointed individuals to
support them. If the medical profession would condescend to employ the
tactics and devices of those questionable, fashionable agencies that
claim the power to cure human suffering, it could quickly reap the
profit and the laudation that it now escapes because it keeps the faith.

The way to be cured of any disease, if it is curable, is to engage a
reputable physician and follow his instructions implicitly. Let him
understand you expect him to see you through your trouble and let him
know you have confidence in him. There isn't one physician in a thousand
who will cheat you under these circumstances.

MALFORMATION.--Under this heading are all those cases of sterility
resulting from imperfect generative organs. These are products of a
failure on the part of nature to furnish or develop the structures
participating in the propagation of the species. The entire generative
organs are sometimes wanting. The womb may have failed for some reason
to grow with the rest of the body, it remains (as it is known) as an
"infantile womb." Occasionally the womb grows together, that is, it is
solid instead of being a hollow organ. The mouth of the womb may be too
small, representing what is called "a pin head opening." The natural
opening is large enough to admit a lead pencil, a "pin head opening"
would not be larger than the lead in the pencil. The latter condition is
quite a common cause of sterility and is readily amenable to treatment.
Most of the malformations which produce sterility are impossible to
cure.

LACERATIONS OR TEARS IN MOUTH OF WOMB.--This subject is fully discussed
on another page of this volume.

TUMOR.--A tumor may be so situated as to prevent conception, or it may
involve the body of the womb constituting a reason in itself for
sterility.

LEUCORRHEA.--Leucorrhea or "the whites" may be of such an acid character
as to kill the spermatozoa in the vagina, or it may be of such volume as
to render impregnation impossible. The treatment of this condition is
discussed elsewhere.

PHYSICAL DEBILITY.--When the general health is bad, no matter from what
cause, sterility usually exists. This lack of vitality may be due to
chronic disease, or it may have been caused by a very severe acute
illness, such as typhoid fever. One's mode of living, if unhygienic, may
be responsible for continued bad health and a consequent sterility.

OBESITY.--Very fat women are usually barren. If a woman rapidly
accumulates fat after marriage she as a rule does not have more than one
or two children. Women often become stout immediately after the child
bearing age ceases.

SPECIAL POISONS.--Certain special poisons in the blood cause sterility
by producing miscarriage.


MISCARRIAGE

By the term "miscarriage" we mean that for some reason the progress of
pregnancy has been interrupted and the fetus is expelled from the womb.
A miscarriage or abortion (both terms meaning the same--the difference
between the two terms is a technical one and need not concern us here)
can occur any time after conception up to approximately the seventh
month, when, if labor takes place, the child may be born alive. The
condition would then be termed a premature labor. A miscarriage or
abortion is an immature labor and implies an immature or dead child.

The condition is a serious one no matter whether it is attended with
grave symptoms or apparently no symptoms. If it occurs shortly after
conception, during the first few months of married life it is serious,
if not in its physical consequences, it is in its significance, because
it establishes the tendency to miscarry,--a tendency that may result in
great mental distress because of the worry and fear it engenders, and of
sorrow and heartache because it may blast the hope of parentage. Such a
miscarriage may take place at once after conception. If so, the
following menstruation may be delayed for a week or so and is then a
little more profuse than is customary. This will be the only indication
that a life has been sacrificed that the young wife may have, and
frequently the significance of such an occurrence is never understood,
yet the tendency to miscarry is nevertheless established, and a seeming
sterility is apparently the fate of the woman. It is, therefore, of the
greatest importance that extreme care should be taken to bring the first
pregnancy to a successful consummation. A young wife should realize that
she is apt to become pregnant at any time. Her conduct therefore should
be such at least as not to harm the life principle with which she has
been entrusted. To this end any excessive sexual activity should be
strictly avoided.

CAUSES OF MISCARRIAGE.--Any strenuous physical effort must be guarded
against. Included in such efforts may be the following: dancing,
running, jumping, surf-bathing, sewing on a machine, sweeping, washing,
house-cleaning, moving furniture, etc. Sometimes the primary cause of a
miscarriage is to be found in some hygienic act, such as a hot bath, too
prolonged or too many hot douches near the menstrual periods. A blow or
a fall, even a fright or shock may cause a miscarriage. Anything that
violently shakes or agitates the womb, which may at this time be
irritable because of its condition, will be sufficient to excite it to
contract and miscarry. Hence violent coughing or vomiting should be
avoided if possible; horseback riding, jolting in a carriage,
convulsions, hysterical crying, may also be the causative factors.
Displacement of the womb by limiting its tendency to grow when pregnant,
may cause it to miscarry. Very severe general diseases such as
small-pox, pneumonia, etc., will cause the womb to empty itself. Disease
of the fetus or the presence of syphilis in either of the parents will
also have the same result.

THE COURSE AND SYMPTOMS OF MISCARRIAGE.--The cause of a miscarriage or
abortion is much the same as an ordinary labor at term. Whatever
interrupts the pregnancy causes the death of the fetus. The dead fetus
acts as a foreign body and excites the womb to contract as it does
during an ordinary confinement. The contractions open up the mouth of
the womb and the fetus is expelled together with its membranes and
after-birth. The significant and the most important symptom of a
miscarriage or abortion is hemorrhage or bleeding from the privates. The
flow of blood may not amount to much or it may be excessive and
alarming; it may not be constant, it may come from time to time in the
form of clots.

The next significant and important symptom of miscarriage or abortion is
pain. The pain, like the flow of blood, may be only slight or it may be
very severe, sometimes it is absent in very early miscarriage. As a rule
the pain is severe when the miscarriage occurs after pregnancy has
lasted for a number of months.

A miscarriage or abortion is said to be "complete" when the fetus with
its membranes and after-birth is expelled clean and whole, or in other
words when the womb empties itself completely. A miscarriage or abortion
is said to be "incomplete" when some part of the embryo is left in the
womb.

WHAT TO DO WHEN A MISCARRIAGE IS THREATENED.--When a woman, who is
pregnant, begins to flow she should at once go to bed and keep perfectly
quiet and send for a physician. A miscarriage is a treacherous condition
and is so regarded by all medical men. It may not amount to much or it
may, on the other hand, develop into a serious situation. The immediate
danger is from hemorrhage; the ultimate or remote danger is sepsis or
blood poisoning. The condition is one that can only be taken in charge
by a qualified physician in whose hands we can safely leave the conduct
of the case.

As a general rule it is quite safe to assert that a woman will not bleed
enough at the beginning of a miscarriage to do any permanent harm.
Consequently there is no occasion for unnecessary alarm. She must,
however, as stated above, heed the warning and go to bed, keep perfectly
quiet and send for a physician. If she fails to follow this advice it is
quite possible that she may have a hemorrhage during the course of the
miscarriage of a sufficiently serious character to endanger her life or
from the effects of which she may suffer for the remainder of her life.

There is practically no danger during the course of or after a
"complete" miscarriage. The danger which may ensue from an "incomplete"
miscarriage is hemorrhage and a form of poisoning caused by the
absorption into the system of putrifying products of the part of the
dead embryo left in the womb.

There are a large number of cases of criminal abortion in which septic
poisoning occurs caused by the utensils or instruments used in inducing
the abortion. All of these cases are operative cases which must be
attended to promptly to save life.

TREATMENT OF THREATENED MISCARRIAGE.--Not all of the cases of beginning
miscarriage end in miscarriage. If the physician is sent for in time he
can very frequently give directions that will, if carried out
faithfully, avert the disaster. Success is more likely to attend those
cases in which the trouble has been caused by some accidental injury, as
a fall, or blow, or extra exertion. This is more especially the case if
the woman has previously borne children, is healthy and in good
condition and whose womb is known not to be diseased. In these cases
there is a partial separation of the fetus from the wall of the womb,
which causes the bleeding. The physician will direct that the woman be
put to bed, in a quiet, darkened room. He will instruct the nurse to
sterilize the external genital region: a sterile gauze dressing is then
left in place. Some form of prescription will be given to diminish the
patient's nervous fear and to allay any tendency on the part of the womb
to contract. It is always essential and very important to save
everything that passes from the womb during the course of a threatened
miscarriage in order that the physician may know exactly just what the
condition is. Each cloth, each clot of blood will have to be examined
before the proper treatment can be pursued in safety.

When the miscarriage cannot be prevented it is called an "Inevitable
miscarriage."

TREATMENT OF AN INEVITABLE MISCARRIAGE.--In these cases every precaution
is taken, just as in a normal confinement, to avert blood poisoning. The
hands, instruments, dressings, etc., are carefully rendered sterile and
the whole field must be surgically clean. The physician will conduct the
case as conditions justify and as the situation develops.

AFTER TREATMENT OF A MISCARRIAGE.--It is one of the many thankless tasks
of a physician's life to insist on each patient staying in bed at least
ten days after a miscarriage. The average woman and frequently the
intelligent woman fails to appreciate the absolute necessity for this
procedure. It is necessary and it is the physician's duty to insist on
it being done in the interest of the woman. Many of the multitude of
diseases of women are caused by disregarding advice on such occasions.

THE TENDENCY TO MISCARRY.--If a woman, for any reason, has had a
miscarriage, her womb will tend to miscarry at the same period during a
subsequent pregnancy. If the miscarriage should occur during her first
pregnancy the tendency to miscarry will be greater than if acquired
after she has had a baby.

This is one of the reasons why young wives often fail to have children.
They "get rid" of the first one or two, because they are not ready to
have children, or because they want some enjoyment themselves before
they are tied down with a family. Having established the habit their
womb has been educated to abort, and it will keep this habit up, much to
their astonishment and chagrin.

Young wives should therefore faithfully follow out all the rules of the
Hygiene of Pregnancy laid down by their physician, and which are given
in detail in this book.

[Illustration: _Courtesy of New York World_

AT WORK WITH THE CALIPERS

Watching carefully the physical development of the child month by month
is one of those many little things which may result in disaster if
neglected.

Abnormal development, or lack of development, should be promptly
reported to the physician, as it may be a warning of serious trouble.

For the table of standards, mental and physical, adopted by the American
Medical Society see page 271.]




THE BABY




CHAPTER XVI

HYGIENE AND DEVELOPMENT OF THE BABY

     What to Prepare for the Coming Baby--Care of the Newly-born
     Baby--The First Bath--Dressing the Cord--Treatment After the
     Cord Falls off--A Pouting Navel--Bathing Baby--Clothing the
     Baby--Baby's Night Clothes--Care of the Eyes--Care of the Mouth
     and First Teeth--Care of the Skin--Care of the Genital
     Organs--Amusing Baby--Temperature in Children--The Teeth--The
     Permanent Teeth--Care of the Teeth--Dentition--Treatment of
     Teething--How to Weigh the Baby--Average Weight of a Male
     Baby--Average Weight of a Female Baby--Average Height of a Male
     Child--The Rate of Growth of a Child--Pulse Rate in
     Children--Infant Records, Why They Should be Kept--"Growing
     Pains."


WHAT TO PREPARE FOR THE COMING BABY.--The physician should instruct the
young wife just what to provide for the coming baby. The following list
will be found useful as a general guide.

     An ordinary clothes basket, padded and lined, is quite
     sufficient for the first month; or, a baby crib, which may be
     cheap or expensive as the individual taste dictates. The Taylor
     crib is probably the handiest and best one on the market.

     Pin cushion;

     Puff-box and puff;

     Soap box containing pure castile soap;

     Hair brush and fine comb;

     Two wash cloths;

     Four ounces of crystal boracic acid, a saturated solution of
     which is used for cleansing baby's eyes and mouth;

     One pound of good absorbent cotton;

     A flexible tube of white vaseline;

     A bath thermometer;

     A package of sterile gauze;

     A half dozen baby towels, good quality;

     A soft, white, good blanket,--one and one-half yards square;

     One pair small blunt pointed scissors;

     A package of the best safety pins;

     Three or four dozen bird's-eye cotton diapers. First size,
     eighteen inches square. Second size, twenty-five inches square;

     One yard of soft white flannel for belly bands; each band
     should be five inches wide, by twenty-four inches long.

     Two silk and wool shirts;

     Three flannel shirts (all shirts should be high necked, long
     sleeved, and open down the front);

     Three Eiderdown wrappers;

     Three Cashmere sacques;

     Three pads for crib;

     Six dresses;

     Six petticoats (they should be thirty-three inches long from
     neck to hem; they should be turned up at the bottom for about
     four inches and should button there to keep the feet warm; if
     it is desired to use pinning blankets for the first two months
     in place of the petticoats, they should be made of soft white
     flannel with cotton bands);

     Six night slips;

     Six pair socks;

     Two cloaks;

     Two hoods;

     One dozen bibs.

Simplicity, warmth, and freedom are the essentials in latter-day baby
clothes. It is cheaper to make the clothes than to buy them. Excellent
and accurate paper patterns can be obtained, giving the quantity of
material necessary and suggesting the kind and quality best suited for
the purpose. These patterns may be obtained from the Butterick
Publishing Company in New York City.

CARE OF THE NEWLY-BORN BABY.--After the nurse has completed her duties
with the mother after the confinement, she will prepare to give baby its
first bath.

The bath should be given in a warm room. This is a matter that should
receive more consideration than has been given it. Nurses do not as a
rule attach much importance to this duty, while in reality it is a most
important one. I have seen trained nurses make ready to give baby its
first bath in rooms, during the night, that were not heated adequately.
I am convinced that many babies have been victims of this careless habit
to the extent of grafting on them the tendency to catarrhal colds and
bronchitis because of undue exposure at this critical period. If one
will remember that a baby has just been removed from an environment
where the temperature was suitable and constant, to one in which it
needs a large degree of artificial heat until such time as it may become
accustomed to the change, one may appreciate the risk taken in exposing
the child for even a short time. The mother should therefore warn the
nurse not to undertake the baby's first bath until the temperature and
other conditions are favorable. Many nurses and other individuals have
the impression, without knowing why, that the baby should be cleansed
and bathed immediately after birth. This is not at all necessary. If the
conditions are not favorable, it would be far better to wrap the baby
snugly in a warm blanket--first having put a diaper on--and place it in
its crib with a hot water bottle near it and defer the bathing until the
following forenoon. By that time the baby will be adapted to its new
surroundings; its lungs will have become accustomed to the air which it
is breathing for the first time; the mother will have been rendered
comfortable; in other words, the conditions and the environment will be
favorable for the baby and for a better performance of the duty.

The next important feature of the first bath is that it should be done
in the quickest time consistent with efficient service. Only the
necessary exposure should be indulged in. It is not necessary that the
baby should be exposed to the admiring inspection of every member of the
household--there will be plenty of time for that without risking the
health of the child. A pan of water at a temperature of 100° F. should
be placed on a stool in front of the nurse. The nurse should have on a
rubber apron, and on top of this, an ordinary apron and a warm bath
towel laid over her knees. The child should be gently rubbed with warm
sweet oil to remove the _vernix caseosa_ (the greasy substance which is
on all babies when born to a lesser or greater extent). Particular
attention is to be given to all folds of the skin, as under the arms, in
the fold of the neck, in the groin, behind the ears, etc., because in
these parts the substance is thickest and if not carefully removed it
will cake, and cause painful eruptions and sores, which may bleed and
render the infant extremely uncomfortable. It is not necessary to
expose the whole body at one time while applying the oil. The lower half
may be covered with a warm soft towel while the nurse is oiling the
upper part, and vice versa. After the body has been thoroughly oiled it
should be cleansed with water at the proper temperature, in which pure
castile soap has been dissolved. Absorbent cotton only should be used to
wash the baby. All the washing is done with the baby on the nurse's
knee; it is not put into the water.

The baby should be mopped dry with sterile gauze, or with a soft sterile
towel, the cord dressed and the flannel band adjusted. It should then be
completely dressed and put to the nipple and later to sleep.

DRESSING THE CORD.--The cord should be covered with powder and sterile
gauze. The powder to use should be plain subnitrate of bismuth. If there
is any reason to use another powder the physician will write a
prescription for it according to indications. The subnitrate of bismuth
will be found much better than any ordinary talcum or toilet powder,
many of which do not make good dressing powders.

Very few nurses know how to dress the cord. It seems to be impossible to
impress them with the need of frequent attention to the cord. Fresh
powder should be put on every time the diaper is removed, every time the
infant urinates, and at other times during the day. The cord should be
kept absolutely dry. Putting on powder twice daily will not keep the
cord dry and many nurses are too lazy to bother to do it oftener. You
cannot make a mistake in putting on too much powder, you can make a
serious mistake by not putting on enough. Every time the cord is
powdered it should be lifted up, away from the skin of the abdomen, and
the powder put below it. The cord should be slightly drawn out and the
powder applied round its base where it meets the skin. Many nurses are
afraid to touch or handle the cord--they find it easier to neglect it.
The mother should see that the nurse dresses the cord at least five
times every day.

APPLYING THE STERILE GAUZE TO THE CORD.--A piece of gauze, six inches
square is taken, a hole is cut the size of a ten-cent piece out of the
center, the cord is drawn through the hole, the gauze folded lengthwise
over the cord and then sidewise, and this is held in place by the
binder. This piece of gauze will adhere to the cord and will most likely
be removed with the cord on the fifth day. If it should fall off,
another piece may be put on in the same way.

If the cord does not fall off until very late it is because it has not
been attended to rightly or because it was a very thick cord.

TREATMENT AFTER THE CORD FALLS OFF.--The stump of the cord should be
powdered with the same powder used on the cord; a pad two inches square
of sterile gauze and quite thick should be held over the stump for a
number of days by the abdominal binder. This is used to prevent a
possible rupture. After a week the size of the pad may be reduced, but a
small pad should be used over the stump of the cord for a month or more.

A POUTING NAVEL.--If the stump of the cord should protrude, a piece of
strong pasteboard, the size of a fifty-cent piece, should be wrapped in
soft gauze and placed over the navel, over this a gauze pad, and if
necessary this should be held in place by a strip of adhesive plaster,
though the binder is usually sufficient if it is put on carefully. If
this pad is held properly and worn for a month the tendency to
protrusion or rupture will have passed away. These pads may of course,
be removed when the baby is being bathed and put back again before the
binder is applied.

BATHING BABY.--A baby should not be put into water for a bath until
after the cord has been off for forty-eight hours.

During the first few months the temperature of the water should be 98°
F. The temperature of the water should be taken with a bath thermometer;
it should not be guessed at. A bath thermometer is an inexpensive
commodity and it will be in daily use in many ways in a home where there
is a baby--it should therefore be procured wherever possible. The room
should be warm; there should be no draughts. The mother or nurse should
cultivate the habit of bathing baby quickly and with system. Everything
should be ready and at hand. A little salt in the water will tend to
strengthen the skin; it will also relieve any superficial rashes or
excoriations which may be on the skin. Four tablespoonfuls to a gallon
of water will be sufficient. The sea salt sold in the stores may be used
in lesser quantities.

By the end of the fifth month the temperature of the water may be
reduced to 95° F., and by the end of the first year to 90° F. After the
first year the mother should accustom the child to a quick sponge with
cool water on the chest and spine immediately after the bath. This
simple means, if kept up, will often prevent the development of colds
and bronchial troubles so common to children in temperate latitudes.

The best time to give the warm bath is at night. In the morning a cold
sponge bath is desirable. This should be given as described in the
chapter on cold sponge or shower baths.

In certain children bathing seems to depress their entire system. They
do not react well even to a warm bath. They remain blue or pale around
the mouth and eyes; bathing should therefore be carefully undertaken
with these children until such time as they acquire strength.

CLOTHING OF BABY.--The baby should wear a woolen shirt, with a high neck
and long sleeves. The abdominal binder may be worn for the first three
months. It is not necessary after that time. If worn longer the habit is
acquired and chronic indigestion may ensue when it is ultimately taken
off. If the baby is very thin it may be wise to leave it on, simply for
its warming effect, for a few months longer. If the child is normal and
healthy the binder should be left off permanently after three months.
The band for the first four weeks should be made of plain flannel; after
this period a knitted band with shoulder straps is the better article.
All petticoats and skirts should be supported from the shoulders.
Stockinet is a good material for diapers; it is soft, warm, and pliable.

Baby's feet should be warm always. Cold feet are frequently responsible
for colic and gastro-intestinal troubles. A hot water bottle should be
placed in the carriage if the weather is cold, but care should be taken
to see that it does not touch the feet, otherwise it may burn them. The
same measure may be adopted in the baby's crib if the feet are cold.

During the summer the outer clothing should be made of the thinnest
quality of material possible, and the underclothing of the finest
flannel or gauze. Body heat may be maintained during changes of
temperature by extra outer wraps--not by dressing the baby in clothes
that keep it too hot and uncomfortable all the time.

The main object to be attained in clothing the baby is to ensure a
sufficient protection, but the clothing must be light, warm, loose, and
non-irritating. Don't bundle up the arms and legs so that they cannot be
moved; don't pin them so tight that the child cannot breathe properly
and don't put the band on so that the child is in torture all the time
from inability to move the abdomen.

BABY'S NIGHT CLOTHES.--The night clothing should be the same as that
worn during the day, but it should be loose and of the lightest flannel
material. For older children a thin woolen shirt (not the one worn
during the day) and a suit of union clothing with feet is best.

The mistake must not be made to cover children too warmly at night. They
can do with relatively less than adults. Too much covering will render
the sleep restless, will encourage nightmare, and in older children will
engender bad habits. Delicate children especially must not be
over-covered at night.

For the first few months children should sleep in a darkened room.

CARE OF THE EYES.--The eyes should be cleansed for the first few days
with a saturated solution of boracic acid. They should be protected from
the direct light for two or three weeks after birth.

CARE OF THE MOUTH AND FIRST TEETH.--Boiled cooled water should be used
to cleanse the mouth every morning after the bath. A soft piece of
sterile gauze should used for this purpose. The mother must guard
against using too much force in cleaning the mouth of an infant.

The milk teeth should receive attention. If they are allowed to become
dirty they will become carious and cause bad breath and neuralgia.
Teeth of this character are a menace to health because they harbor germs
and in this way infect the mouth and cause stomach troubles. Teeth that
are carious should be filled or removed.

CARE OF THE SKIN.--The skin of a baby, because of its delicate
character, is susceptible to the slightest changes in the weather or to
the condition of the digestive organs. Babies are frequently subject to
rashes, intertrigo, excoriations, eczema, and other skin affections. It
is much easier to prevent these conditions than to cure them.
Cleanliness, not only in giving a daily efficient bath, but in every
other respect, is essential. Castile soap only should be used, and no
rubbing indulged in, simply mopping the parts with gauze well saturated
with soapy water. All napkins should be removed as soon as soiled. If
the skin is easily chafed the child should be bathed in salt water or
water in which bran is mixed as explained in the chapter on bran baths.

The baby should be well powdered with a good quality of toilet powder.
Ordinary starch, or talcum, or the stearate of zinc is suitable. Fat
infants should be powdered in all the skin folds; otherwise they are
sure to chafe.

CARE OF THE GENITAL ORGANS.--The mother should make it a habit to remove
any dirt from the genitals of the baby during the morning bath. Fecal
matter sometimes gets into the folds of the female baby; this should be
removed promptly. In older female children, dirt and dust get into the
genitals which often has to be removed carefully with a soft piece of
cloth. An exceedingly chronic form of inflammation is often seen in poor
children because of neglect of these parts.

In male babies the mother must daily push back the foreskin and clean
under it. If this is not done the natural secretion will gather there
and cause much trouble. If the foreskin is long, the child should be
circumcised; if it is not long it must be pushed back daily for a number
of weeks; otherwise it will contract and it may be necessary to operate
on it at a later date. If this is not faithfully attended to the prepuce
will become adherent, the child becomes nervous and irritable, and it
may become addicted to self-abuse at a very early date--simply because
the mother is derelict in the performance of her duty. If you are afraid
to do your duty, don't neglect it, ask the doctor to show you just what
has to be done and just how it should be done. You will find it to be a
simple matter when you know how, as most things are.

AMUSING BABY.--Mothers should understand that it is not necessary to
amuse a baby under one year of age. Their nervous systems are not ready
for any such sport. To excite a baby to laughter is to subject it to a
shock which may injure it. The healthy development of the brain of a
child demands quiet and restful surroundings. It should sleep, eat, and
be allowed to amuse itself in a natural way.

TEMPERATURE IN CHILDREN.--The normal temperature in a child varies more
than it does in an adult. The rectal range may be between 98° and 99.5°
F. and may be normal to that particular child. A rectal temperature of
97.5° F. or of 100.5° F. is of no importance unless it continues.

The best place to take the temperature in a child is the rectum and the
next best place is in the groin. The temperature will always be from a
half to a full degree higher in the rectum than in the groin. The
thermometer should be left in the rectum for two minutes, and in the
groin for five minutes.

The temperature in a child is a very fair guide as to the severity of
the disease. It must be remembered, however, that a child will develop a
temperature of two or three degrees from a very slight cause. It is not
the height of the fever that is significant, but rather the duration of
the fever that is important. A fever of 102° F. in a child may only mean
a slight indigestion which will wholly disappear after a laxative is
given, while the same degree of temperature in an adult usually means
something much more serious. The degree of the temperature therefore
should not occasion unnecessary worry; if, however, it continues and if
the child shows other signs of illness, it may be regarded as indicating
an abnormal condition which should be immediately found out. A
temperature of 100° F. to 102° F. usually means a mild illness, and one
of 104° F. or over, a serious sickness.

It is not advisable that the ordinary mother should possess a clinical
thermometer. There are many occasions when a child will have a fever
which should not cause any worry; if the mother gets the thermometer
habit, she will many times occasion unnecessary calls of the physician
only to learn that they are false fears.

THE TEETH.--There is no definite time at which the first teeth appear.
They usually come between the sixth and eighth months. They may not,
however, come until much later; or they may come earlier than the sixth
month; and yet the child may be perfectly healthy. They come as a rule
in the following order:

    1. The two lower middle teeth,                           6 to 8 months.
    2. The four upper middle teeth,                          8 to 10 months.
    3. One on each side of two lower middle teeth,           8 to 12 months.

    4. One on each side, above and below, back of
       above teeth (four in all),                           12 to 15 months.

    5. The next one on each side, above and below, back of
       those already in (four in all),                      18 to 24 months.

    6. The four back teeth on each side, above and below,   24 to 30 months.


    At 1 year a child should have                  6 teeth

    At 1-1-2 years a child should have            12 teeth

    At 2 years a child should have                16 teeth

    At 2-1-2 years a child should have            20 teeth

They may not come in the above regular order even in well children. The
upper front teeth may come first. If the child is sickly there may be
marked irregularity in the order in which they appear. Twenty teeth
comprise the first set.

THE PERMANENT TEETH.--This set consists of thirty-two teeth. They begin
about the sixth year and they are usually not complete until the
twentieth year. They appear in the following order:

    First molars                6 years
    Incisors               7 to 8 years
    Bicuspids             9 to 10 years
    Canines              12 to 14 years
    Second molars        12 to 15 years
    Third molars         17 to 25 years

CARE OF THE TEETH.--The teeth should be given attention as soon as they
appear. It is an excellent custom to wash the teeth and gums twice daily
with a piece of clean absorbent cotton rolled round the finger of the
mother and dipped in a saturated solution of boracic acid. This should
be done up to the second year. After the second year a soft brush should
be used and the teeth thoroughly cleaned morning and night with pure
castile soap or a powder. The teeth of every child should be examined by
a dentist every six months. All cavities should be filled with a soft
filling. The milk teeth should not decay, but should fall out, or be
forced out by the second set. A child should be taught to gargle early
and a mouth wash should be used morning and night.

DENTITION.--As a general rule the process of teething is accompanied by
some symptoms. There may be fever, restlessness, and loss of appetite;
though in many cases there are absolutely no symptoms. Some children
seem to teethe hard, others easily. The same child may have some teeth
without pain, and with others it may suffer severely. The condition of
the child at the time, its age, and the season of the year undoubtedly
have an influence. Children who are sickly and puny may have much
difficulty while teething.

The degree of sickness varies quite considerably. There may only be, as
stated above, slight fever, restlessness, with loss of appetite; or
there may be, in addition to these symptoms, a pronounced fermentative
diarrhea, which may lead to serious intestinal diseases; frequently
there is a cough. This is more apt to be the case if the child is
teething during the hot season.

TREATMENT.--When dentition affects the child's disposition it is a good
plan to reduce the feeding in quantity and quality for the time being.
If the child is bottle-fed, two ounces can be taken out of each bottle
and one ounce of boiled water added. If the child is breast-fed, he
should be given two ounces of warm, boiled water before each feeding,
and the actual feeding time at the breast shortened.

Rubbing the gum over the erupting tooth with a clean cloth may aid in
helping it through. If the child is very restless and has lost sleep,
the cloth may be moistened with brandy and water. Lancing the gum,
though it is seldom done now-a-days, is justified in a few cases.
Teething is not the cause of actual disease as was once thought, but it
must be remembered that a child whose vitality is reduced by fever,
restlessness, loss of appetite, loss of sleep, and irregular bowels, is
more susceptible to disease than when enjoying robust health.

Sometimes a child will have a fever for one or two weeks during a hard
dentition. There is apt to be more or less intestinal indigestion and
fermentation at this time and as a consequence actual intestinal disease
may develop. To avoid such a possibility it is an excellent plan to give
an occasional dose of castor oil to clean thoroughly the whole
intestinal canal. This should be done irrespective of the condition of
the bowel, because frequently a diarrhea is caused by retained
fermenting products.

Mothers must not acquire the habit of attributing all symptoms to the
teething process simply because the child is teething. It must be
remembered that a child may get a disease, or an ailment, while
teething, that has nothing to do with teething. If this is neglected,
serious consequences may result. Many children have lost their lives by
a mother's carelessness in this way. Be on the safe side, consult your
doctor; let him assume the responsibility.

HOW TO WEIGH THE BABY.--The test of weight is one of the most
satisfactory we possess as an indication of physical progress and
health. It is not an absolute test, but it may safely be relied upon.
The fattest baby is not necessarily the healthiest. A gradual and a
uniform increase is a satisfactory growth. At birth a baby weighs, on an
average, from seven to eight pounds, though some babies weighing less
are equally healthy. The normal and customary gain is from four to six
ounces every week after birth.

The baby should be weighed about the same time of the day each week, and
before a meal.

The average weight of a male child at different ages is as follows:

    Birth                     7-1/2 lbs.
    3 weeks                       8 lbs.
    1 month                   8-1/2 lbs.
    3 months                     12 lbs.
    4 months                 13-1/2 lbs.
    5 months                     15 lbs.
    6 months                 15-1/2 lbs.
    7 months                     17 lbs.
    9 months                     19 lbs.
    1 year                       21 lbs.
    1-1/2 years                  23 lbs.
    2 years                  26-1/2 lbs.
    3 years                  31-1/2 lbs.
    4 years                  35-1/2 lbs.
    5 years                      40 lbs.
    6 years                      45 lbs.
    7 years                      49 lbs.
    8 years                      54 lbs.
    9 years                      59 lbs.
    10 years                 65-1/2 lbs.

A female child weighs about one-fifteenth less than a male child, as a
rule.

Table showing the average height of a male child, at different ages:

    At birth             20-1/2 in.
    6 months                 26 in.
    1 year                   29 in.
    2 years              32-1/2 in.
    3 years                  35 in.
    4 years                  38 in.
    5 years              41-1/2 in.
    6 years                  44 in.
    7 years                  46 in.
    8 years                  48 in.
    9 years                  50 in.
    10 years                 52 in.

THE RATE OF GROWTH OF A CHILD.--A child grows most rapidly during its
first year--six to seven inches; from fourth to sixteenth, about two
inches annually; thence to twentieth, one inch. Commonly, a child at two
and a half years has attained half of its ultimate adult stature. The
diseases of youth always accelerate growth.

PULSE RATE IN CHILDREN AND ADULTS.--Normal Pulse,--of new born, 130 to
140, per minute; first year, 105 to 115; second year, 106 to 115; third
year, 95 to 105; fifth to twelfth year, 80 to 90; thirteenth to
twenty-first year, 75 to 80; twenty-first to sixtieth year, 70 to 75; in
old age, 75 to 85.

INFANT RECORDS.--A record should be kept by the mother of every child
which would embrace exact data as to weight, diet, size, development of
mental power, teeth, ailments, sickness, pains, etc., with dates and any
information which would aid in recalling exact conditions. Such records
are of the utmost value in a number of ways. They help in giving
suggestions as to diet, general health, and mental qualities of the
child in question, and they aid in furnishing what physicians call "past
history," which past history has a very valuable significance in
estimating the character and importance of sickness during later years.

Such a record is also of importance in comparing a child's development
with what is regarded as standard development, and also with the growth
and development of other children in or out of the family.

If a child should thus be found to fall seriously below the standard and
yet not appear actually sick, a very thorough and routine investigation
should be instituted to discover if possible the cause. Some error might
thus be detected which might seriously affect the child's future growth
and well-being.

The date of the closing of the soft spot on the baby's head should be
noted, and if it is still open, when it should be closed, it might mean
that the child has a serious brain condition. The soft spot should close
between the eighteenth and twenty-fourth months. The family physician
should be notified if the soft spot is open later than the second year,
as he may want to investigate the cause.

Should the child be unusually backward in walking, and when it does so
should limp and feel pain in the knees, it should be examined for any
symptom of hip joint disease, of which these are the earliest signs.

If the child complains of so-called "growing pains," keep in mind that
these are rheumatic and may need attention. There are no such pains as
actual "growing pains," that is, pains caused by the child growing.




CHAPTER XVII

BABY'S FEEDING HABITS

     Overfeeding Baby--Intervals of Feeding--How Long Should a Baby
     Stay at the Breast--Vomiting Between Feedings--Regularity of
     Feeding--Why is Regularity of Feeding Important--"A Baby Never
     Vomits"--What is the Significance of So-called Vomiting After
     Feedings--Mothers Milk That is Unfit for Baby--Fresh Air for
     Baby--Air Baths for Baby.


OVERFEEDING BABY.--Every nursing mother should have printed and hung up,
so she may read it every time she nurses her child, the following motto:
"DON'T OVERFEED BABY." Few, if any, babies die of willful starvation:
many die as a result of overfeeding. Mistaken kindness and lack of
judgment are responsible for one-half of all the troubles of infancy.
Babies require much less than is constantly given them. The stomach of a
baby at birth will not hold more than one ounce, which is two
tablespoonfuls; and at two months it will not hold more than three
tablespoonfuls; and at six months, six or seven tablespoonfuls. Read
these quantities once again carefully and try to realize the
significance of the smallness of them. A baby is just like a little pig;
it will go on feeding as long as it is allowed. The baby does not
reason; it has no judgment; it depends upon its mother's judgment. If
the mother is false to the trust the baby overloads its stomach. A
swollen, distended, overloaded stomach causes indigestion. A baby with
indigestion is a colicky, fretty, sick baby. Overfeeding, therefore, is
the beginning of lots of trouble to the mother, and needless pain and
suffering and sickness to the baby. A simple matter, but it is one of
the most difficult lessons nursing mothers have to learn.

Overfeeding is most apt to occur at night. Many mothers put the child to
the nipple for its regular feeding and fall asleep; the child keeps on
nursing at intervals until twice the proper quantity is taken; or she
gives it the nipple or the bottle if it cries, without regard to whether
it is the proper feeding time or not. The habit of overfeeding is very
common in infants who are suffering from indigestion. They cry
frequently, and are irritable most of the time; nothing seems to satisfy
them but the nipple. Taking the warm milk into the stomach seems to
allay the distress for the time being, so mothers get into the habit of
quieting them in this way. The cry of the drinking man, whom we try to
sober up, is: "Just one more drink and I'll quit." You give the drink
and in a little while the demand is repeated. If the mother understood
the seriousness of this practice of giving the child the nipple or
bottle at irregular times, she would not do it.

Overfeeding an infant may lay the foundation for a lifelong ailment. The
excess of food remains in the stomach or bowels undigested. If you
remember that this mass of undigested matter is confined in a small
space which is both warm and damp, it will be easily understood that
putrefaction is the inevitable outcome. As a result of this putrefaction
there are produced certain ptomaines and leucomaines. These poisons are
carried through the body, causing "auto-intoxication" which upsets and
irritates the child's nervous system and may cause very serious
consequences, as it frequently produces sudden death from apoplexy and
"heart failure" in the adult. These children are always restless,
fretful, continually uncomfortable, sleepless and colicky. They lose
weight, the stomach becomes distended and a gastritis or inflammation of
the stomach results.

Frequently a mother with such a fretful baby, seeing her child getting
thinner and thinner, will think that it is not getting enough to eat,
and will proceed to add to the trouble by giving the child more to eat.

Mothers must therefore learn not to overfeed their infants; not to
imagine that a failure to gain weight means the need of more food (if
the quality of the food being given is wrong, will increasing the
quantity of bad food do any good?); not to feed irregularly, no matter
how insistent the child may be.

INTERVALS OF FEEDING.--The physician will give instructions regarding
the feeding of the newly born baby for the first few days. After the
first few days and up to the beginning of the third month, it should be
fed every two hours from 7 A. M. until 9 P. M., and twice during the
night between 9 P. M. and 7 A. M., when the regular two-hours' interval
again begins for the following day. The two night feedings should be
about 1 and 4:30 A. M.

After the third month, and up to the sixth month, feed every three hours
and once during the night. From the sixth month until weaned, every
three and one-half or four hours, and not at all during the night.

While it has been pointed out that regularity of feeding is absolutely
essential, the above schedule is not to be regarded as an absolute
guide. It is a general guide,--approximately it will be found correct in
a large majority of cases. Each baby is a rule unto itself. The quantity
of the mother's milk will dictate the interval after the first month and
for each month as the baby grows. If a mother with no milk to spare, is
nursing a big, strong, husky baby, the three-hour interval during the
day may have to be shortened to two and one-half hours. As a rule,
however, these exceptions are better regulated by attention to the time
the baby is given at each nursing to fill its stomach.

HOW LONG SHOULD A BABY STAY AT THE BREAST?--Babies differ as to their
method of feeding; some of them seem to like to nurse a moment or two
and then look around; others seem to regard nursing as a serious
business, and resent any effort to take the nipple away until they have
finished. A baby should be taught to nurse methodically; it should not
be allowed to play the nipple. Let it fill its stomach and put it down
as quickly as possible. A mother will very soon know just how long it
takes the baby to fill its little stomach, and when she finds this out
she should time it by the clock. When the supply of milk is sufficient,
and the child is strong, and nurses freely, eight to twelve minutes are
sufficient. After it is taken away from the breast it must be left quiet
till the next feeding.

Other babies, according to the ability they evince to nurse, even when
the milk runs freely, require a longer time,--from twelve to fifteen
minutes. The rule, however, is never to allow them to nurse so long that
when they are taken away the milk runs out of the mouth. If this occurs,
cut down the length of time they are at the breast, and always time the
length of feeding by the clock,--don't guess at it.

CHILDREN WHO "VOMIT" BETWEEN FEEDINGS.--When a child habitually brings
up food between feedings it is usually a symptom of gastric indigestion.
In these cases it is advisable to add lime-water to each feeding, and to
remove some of the fat in each feeding. If improvement does not follow
remove more of the fat by removing some of the cream from the top of the
bottle before shaking it.

Remove from the bottle four ounces of cream and shake before preparing
the food from what is left. If the child improves after a few days
remove only three ounces, then in a few days remove two ounces and later
one ounce. After a time, sufficiently long to permit the stomach to
become accustomed to the graded amounts of fat, the former diet of whole
milk can be again resumed.

Never decrease the interval of feeding of a baby who is bringing up
parts of its meal between feedings; it is frequently advisable to
increase the interval. If a child is colicky and is bringing up lots of
gas in addition to some food, one-half grain of benzoate of soda may be
added to each ounce of food given and continued for a number of weeks if
necessary. When the gas is located in the intestines and is not brought
up, it must be made to pass downward. Attention to the bowels is of
great importance in these cases and it may be necessary to peptonize the
milk for some time. A reduction of the sugar and starch in the feeding
frequently cures this condition. (See "Colic.")

There are children who continue to have symptoms of indigestion and who
do not thrive despite various changes in the quantity and quality of the
feedings. It may be necessary to obtain a wet nurse for them, as it is
with "the delicate child." If a wet nurse cannot be obtained, or if the
age will permit, a substitute may be tried. Borden's Eagle brand of
condensed milk, canned, is probably the best substitute under these
circumstances. Condensed milk should never be used as a continuous food;
as a substitute, however, for a few weeks it is often invaluable. With
an infant of three or four months it should be used at the beginning in
the proportion of one ounce of the milk to sixteen ounces of plain
boiled water or barley water. The proper quantity, whatever the child is
taking (four or six ounces according to the age) at the time, can be
taken from the sixteen ounces and fed to the child. As the symptoms
improve the milk should be diluted less and less, 1 to 14, 1 to 10, and
so on until the proper strength is reached. After the child has been on
the condensed milk for a month it should be changed back to cow's milk,
using of course a diluted formula until the child becomes accustomed to
the change. Condensed milk, if used as a permanent food, will fatten
babies, but their vitality is very deficient, the muscles flabby, and
the resistance to disease exceedingly poor. They are apt to develop
rickets and sometimes scurvy.

REGULARITY OF FEEDING.--One of the very first, and one of the most
important factors in contributing to the good health and the comfort of
a baby is absolute regularity in feeding. A regular interval of feeding
is particularly essential during the first month of a baby's life.

Despite the explicit way in which young mothers are instructed in this
respect, it is one of the disappointing incidents of the practice of
medicine to observe how many of these mothers fail to heed the advice.
We have personally tried to find an explanation for this astonishing
carelessness, and have come to the conclusion that it is not due to
intentional forgetfulness, but rather to an inexplicable failure to
appreciate that the physician means exactly what he says.

If, for example, specific instructions are given to feed, or nurse, the
child every two hours (and by "specific instructions" it is meant, that
the physician takes time to explain in detail the instructions he
gives--that the instructions are not incidental to the call, but part
of the call;--that the advice is given not as a choice of what is
desirable, but as an absolute rule to follow; and carefully explains why
it is imperative to do as he says; and is satisfied the mother
understands what he means) it would seem that there could be no possible
reason why the directions should not be faithfully carried out. Yet such
is not the case in many instances, and the excuses given by mothers for
failure are so trivial and annoying that they show a failure to
appreciate that they are dealing with a serious problem--a problem
affecting human life. They fail to understand that fatal consequences
may follow their negligence. They treat the baby problem exactly as they
would a household incident, and as they do not consider it important
whether the breakfast dishes are washed at 9 A. M. or at twelve noon,
neither do they consider it important whether the baby is fed at 9 A. M.
or an hour later. When mothers learn that the attention they must give
their babies is essentially different from the attention they give
ordinary household duties, the problem of raising children with success
and comfort will be greatly simplified.

If the instructions are to feed the baby at certain intervals, do so at
all hazards. To offer the foolish excuse that the baby was asleep when
feeding time came, is no excuse at all; as a matter of fact the baby
should be asleep at each feeding time, if it is healthy. Wake it and
feed it, for, as will be shown later, it is the constant regularity that
counts. It will be more difficult to institute regular feeding intervals
during the first month, because a healthy baby is very difficult to wake
up, even to be fed, during the first few weeks of life. It is absolutely
essential, however, that it should be wakened: otherwise the tendency to
overfill the stomach at the next feeding will lead to indigestion and
colic.

WHY IS REGULARITY OF FEEDING IMPORTANT?--Because a baby's stomach holds
a very small quantity, and experience has taught us that a baby will
thrive better on small quantities given frequently, rather than large
quantities at longer intervals. The smaller the baby, the smaller the
quantity to begin with. Some babies weigh from five to seven pounds at
birth, while others weigh from nine to twelve pounds. It would be
unreasonable to expect a very small baby to be able to hold and digest
as much as a very large baby. Considerable common sense and the exercise
of some judgment is therefore necessary on the part of the uninstructed
mother, as to just the right quantity to give. Fortunately, a little
experience will enable the observant mother quickly to solve this
important problem. Nature promptly furnishes the symptoms which will
correctly guide her. Before considering the significance of these
symptoms let us appreciate certain facts common to all babies, and we
will more easily interpret the meaning of the special symptoms the baby
will furnish.

First of all the baby never vomits. The ejection of food, therefore, is
dependent upon a condition, not a disease. If milk runs out of its mouth
immediately, or within a few moments, after a feeding, the explanation
is that it was fed too much; it does not vomit, the stomach simply
overflows. It is exactly like trying to put more milk into a cup after
it is full,--it will not hold more, it overflows.

The significance of this symptom, therefore, is that the quantity of the
feeding is wrong (it is not the baby's stomach that is at fault,--it is
the mother's judgment). Reduce the quantity of each feeding and you will
quickly cure it. If the milk does not overflow soon after a feeding, the
baby will appear satisfied and will go to sleep, and will sleep until it
is time for the next feeding. It may not do this, however. In half an
hour, or a little longer, after the feeding, it wakes, it begins to fret
and cry, and very soon it suddenly belches gas and ejects a mouthful of
milk, after which it will rest quietly for a few moments, when it will
begin fretting all over again. It may keep up this performance for an
hour, or until the next feeding, and if so it is exhausted and unfit to
carry on the digestive process. It is in these cases where most mothers
make serious mistakes. This is the beginning of real trouble, and the
family physician is the only one qualified to give advice under such
circumstances. Remember the warning given regarding heeding the advice
of every busybody just at this time. Your baby's health is at stake;
maybe its life depends upon what you choose to do.

WHAT IS THE SIGNIFICANCE OF "VOMITING" AFTER FEEDINGS IN BABIES?--Let us
examine the difference between the milk which overflowed immediately
after the feeding and the milk which the baby ejects one-half hour or so
later, and which is now being considered.

The first milk looks like ordinary milk (breast milk), or if the baby is
being fed from the bottle, it looks just like the mixture in the bottle.
It not only looks like what it took, but it smells just like it. Now
examine the other; we find it looks like curdled milk, it is lumpy, and
we immediately can tell that it is sour, because it smells sour and
looks sour.

The explanation of the first overflow (immediately after the feeding)
was the too great quantity; the explanation of the second overflow
(one-half hour or so after the feeding), is the wrong quality of milk.
The quantity was right because none overflowed right after the feeding,
but the quality was wrong. Again, it is not the baby's stomach that is
at fault,--it is the quality of the milk.

How do we know this? Because of what takes place in the baby's stomach
during the one-half hour between the feeding and the time of the
overflow of the sour milk. The quantity being right, why should the baby
have any trouble if the quality is correct? It should not. Therefore by
changing the quality (not the quantity as in the former case) we cure
the trouble, thus proving the quality of the milk to be at fault.

What took place in the baby's stomach in the intervening half hour? The
quality being wrong, the little stomach could not digest the mixture
quick enough. Fermentation set in, gas was evolved, and as the stomach
was full before the gas was manufactured (and as more and more gas is
manufactured when food ferments), the stomach overflowed and out of the
baby's mouth comes gas, and sour, fermenting, curdled milk. This process
goes on until fermentation stops, or until the little stomach has just
enough left to fill it and no more. But think what this is,--a sour mass
of rotting, indigestible, curdled milk,--and that is what this baby is
expected to live and thrive on.

Some babies seem to have trouble from the very first day of life. Either
they will not retain the food, or the food fails to agree with them. If
the baby is put upon artificial food at once, these troubles are, of
course, not unexpected (because the right artificial food may not be
first chosen for the particular baby), but it is not always the
artificially fed baby that gives us trouble, and it is sometimes
difficult to find the cause for such trouble in a baby who has had
nothing but its mother's milk since it was born.

The cause of stomach trouble in a baby a few days old, fed exclusively
on mother's milk, is invariably to be found in the quality of the milk.

The quality of the mother's milk may be affected in a number of ways
which will render it unfit for the baby. For example, if the mother for
any reason becomes sick, and has a high fever shortly after confinement,
it will affect her milk and render it unfit temporarily.

If the mother worries or becomes highly nervous during the first few
days of her baby's life, she will so affect her milk as to render it
unfit for baby. If a baby is fed for a number of days after its birth by
its mother, and it should prove afterward that she has not enough milk
to continue feeding it, and has finally to put it on artificial food,
the baby will most likely have acquired slight stomach ailments that may
be troublesome for some time, because in this case both the quality and
the quantity were no doubt wrong. Constipation in the mother will also
cause trouble. The child will develop colic and extreme irritability
until the mother's condition is relieved.

Each of these conditions affecting the milk of the nursing mother
usually demands a change of food for the baby, and the substitution of
the proper artificial food will invariably immediately correct the
trouble. In some cases, however, the quality of the mother's milk is not
dependent upon a temporary temperamental condition, but is caused by
errors in diet, or conduct, or both. The milk of a physically tired,
worn-out mother, is not good, no matter whether the exhaustion is caused
by actual physical labor or by the exactions of a strenuous social
programme. The milk of a mother who persists in eating irregularly, or
who willfully caters to an appetite which craves the rich, highly
seasoned articles of diet, or who attempts to satisfy a legitimate
hunger by drinking large quantities of stale tea or coffee and eating
bread, is unfit for her baby.

These cases are amenable to the proper treatment, which of course means,
that the mother must change her conduct if at fault, and live strictly
upon the diet prescribed elsewhere for nursing mothers.

If these troubles occur in babies who have been fed exclusively upon
artificial food, an entire change of food is frequently necessary.


FRESH AIR FOR BABY

Baby's first journey out of doors depends upon so many contingencies
that no specific age can be given when it would be perfectly safe to
take it.

First, the weather and season of the year should be considered. The baby
should not be taken out at all when it is wet, or foggy, or very humid;
nor when it is extremely cold.

Second, the vigor or vitality of the individual child must be
considered. Some children can safely be taken out if the weather is
propitious when two weeks old, others cannot be taken out without risk
until they are two months old, regardless of the weather conditions. If
a child is robust at birth, and nurses well, and increases in weight
from the beginning, he can be taken out when he is two weeks old while
the sun shines during the middle of the day. If a child is small and
puny when born, and begins to have nursing troubles from the beginning,
does not increase in weight, is fretting, and crying, and sleeps
spasmodically, it would be unsafe to take it out before the sixth week
unless it is at a season of the year which would justify exposure to the
sunshine.

The question of suitable clothing will be important, and will decide the
advisability as to when the baby should go out. Every baby should be
dressed in wool weather is not too distinctly bad. Remember always to
[Transcriber's note: words missing in text] from neck to ankles. Its
head should be warmly clad. Dressed thus and well wrapped in blankets, a
healthy child is ready for an out-door trip at any time, if the
[Transcriber's note: words missing in text] have plenty of blankets
below the child as well as above it, if it is in a baby carriage. In
very cold weather the child should be buried in blankets, and a hot
water bottle can be wrapped in near his feet. Great care must be taken
that the water in the bottle is not too hot, and that it does not
actually touch the skin. No matter how many or how few blankets are
used, the face should be exposed directly to the fresh air. When the air
is very gusty, or high, a light veil can be laid over the face, but
never at any other time.

AIR BATHS FOR BABIES.--Babies necessarily require plenty of exercise and
plenty of fresh air, as has been pointed out. It is a splendid custom to
allow the baby to lie naked after his bath for half an hour. If the room
is comfortably warm, select a spot that is free from draughts, and lay
the baby on a pillow or two and let him kick and coo. In the sun by the
window, his head and especially the eyes shaded from the direct rays of
the sun, is an excellent place in the summer time. The influence of the
direct sun rays on the little naked body is conducive to good sturdy
health, good nerves, and sound sleep.




CHAPTER XVIII

BABY'S GOOD AND BAD HABITS. FOOD FORMULAS

     Baby's Bed--The Proper Way to Lay Baby in Bed--Baby Should
     Sleep by Itself--How Long Should a Baby Sleep--Why a Baby
     Cries--The Habitual Crier--The Habit of Feeding Baby Every Time
     it Cries--The Habit of Walking the Floor with Baby Every Time
     it Cries--Jouncing, or Hobbling Baby--Baby Needs Water to
     Drink--The Evil Habit of Kissing Baby--Establishing Toilet
     Habits--Baby's Comforter--What can be Done to Lessen the Evil
     Effects of the Comforter Habit--Beef Juice--Beef Juice by the
     Cold Process--Mutton Broth--Mutton Broth with Cornstarch or
     Arrowroot--Chicken, Veal, and Beef Broths--Scraped Beef or Meat
     Pulp--Junket or Curds and Whey--Whey--Barley Water--Barley
     Water Gruel or Barley Jelly--Rice, Wheat or Oat Water--Imperial
     Granum--Albumen Water--Dried Bread--Coddled Egg.


BABY'S BED

THE PROPER WAY TO LAY BABY IN ITS BED.--The baby should be accustomed to
sleep by itself from the day of its birth. Mothers have been known to
smother their babies during sleep. The mother may pull the bed-clothing
over the baby's head during the night and thus deprive it fresh air. A
mother is much more apt to nurse her baby regularly and to do it more
efficiently, if she is compelled to get up to do it. If she occupies the
same bed with baby, she may fall asleep while nursing him; the baby
consequently nurses too long, fills his stomach too full, and soon
develops indigestion and colic in addition to acquiring a very bad
habit.

For the first few weeks an ordinary basket arrangement is all that is
necessary. As soon as the baby begins to move around it should have a
regular baby crib, so that possible accidents may be avoided.

When the baby is placed in bed after a feeding, it should be laid upon
its back, being tilted slightly toward its right side. By placing a
soft, small pillow, under its left side, the baby will rest more on its
right side, which is the proper position. The reason of this is because
the liver of a child grows quicker and larger than any other organ, and
it is on the right side. By placing the child on this side, it prevents
the heavy liver from sagging over on the little full stomach. If the
child were laid on its left side, the liver would crowd the full stomach
and embarrass the heart, and cause pain and restlessness. Frequently a
change of position fully to the right side, when a child has been
restless or crying, and especially if it has been lying on its back,
will at once relieve it and allow it to go to sleep again. It is the
knowledge of these little things that count in babyhood.

HOW LONG SHOULD A BABY SLEEP?--A perfectly healthy baby should sleep,
while very young, eighteen or twenty hours out of the twenty-four. As it
grows older it will sleep less. It should have, and nothing should
interfere with its having, two sound naps every day,--one in the
forenoon after its bath, and the other in the afternoon. When four or
five months old, it should also sleep from 7 P. M. until 10 P. M., then
it should be fed and allowed to sleep until morning. It has been aptly
said, that, "a child might easily overeat, but he practically never
oversleeps." During the second year a child should sleep twelve hours at
night, and about two hours during the day. The twelve-hour night rest
should be continued until the child is six years of age. The practice of
taking a nap at noon is a very good one, and it should be encouraged as
long as possible. It can usually be kept up until the child begins
school life. The strenuous activity of childhood, makes some such rest
highly desirable, and the result will necessarily be a stronger body, a
better disposition, and firmer nerves than otherwise. The practice of
retiring early should be strictly enforced during childhood. Children of
two years of age, should retire at 6:30 P. M., or at latest at 7 P. M.,
those from three to five years, may remain up an additional hour. At
thirteen or fourteen the regular bedtime should be at 8:30 P. M. There
is no justification for the late hours which growing children are
allowed to keep, especially in large cities.

Regular sleep is largely a matter of habit, and if the infant is started
right, with suitable feedings, given at definite times, followed by the
proper periods of sleep, but little trouble will be experienced with
sleeplessness. When sleep is disturbed and broken, it means bad habits,
unsuitable food, minor forms of indigestion, or positive illness of some
kind. Sleep is absolutely essential in infancy and all through childhood
for purposes of growth. It is wrong to permit a child to sleep too much
during the day; it will become a habit, and it will not sleep well
during the night as a consequence. In order to prevent or break this
habit, the child should be kept in a well-lighted room and should be
amused and entertained so as to keep it awake. The nap during the middle
of the day is an exceedingly important factor in keeping the average
child in good physical condition. It is a valuable adjunct in
preventing, and in treating, nervousness in children. Children who are
anemic should be encouraged to sleep long and freely in well-aired
rooms.

WHY A BABY CRIES.--As has been stated, every healthy baby should cry for
half an hour each day. Nature suggests, demands this as an essential
exercise. Muscular movements involving a greater part of the whole body
accompany the act of crying and furnish this necessary exercise. It is
of great importance to an adequate and uniform development of the lungs;
deep breathing is necessary to lusty crying, hence the lungs are
expanded and the blood renewed and oxygenated. Crying is also of
material aid in moving the baby's bowels. Babies in perfect health will,
however, cry under any of the following circumstances, and doubtless
under circumstances of lesser importance and frequency when frightened
or uncomfortable from hunger or position, soiled napkins, inflamed
buttocks, earache, pain, from heat or cold, unsuitable clothing, and
during difficult bowel movement, when displeased or angry. Children
slightly but painfully ill may cry incessantly for an hour or two. Thus,
with intestinal colic, when the cry is loud and continuous until the
child is relieved or until he falls asleep from exhaustion.

The healthy, well trained child seldom causes trouble; it is the rule
for it to be happy and good natured in its own way.

THE HABITUAL CRIER.--If a child becomes a habitual crier, it is because
it is uncomfortable and unhappy. There are restless, often vigorous,
crying, whining infants, and the trouble, as a rule, is in the
intestinal tract. Badly managed, "spoiled babies" cry from inattention,
and when left alone. If they are taken up and talked to, the crying
ceases, thus proving that it was not pain or discomfort that was causing
the crying. In the case of the habitual crier we try to find out the
cause of the bowel trouble and cure it; the spoiled infant we discipline
rigidly, or leave it alone if its parents prefer that kind of baby.

THE HABIT OF FEEDING BABY EVERY TIME IT CRIES.--The habit of regular
feeding will, if persisted in and successfully established, render
advice on this subject unnecessary. So also will the explanation of the
evil of overfeeding have its effect on mothers. Apart from these
reasons, however, the habit of feeding baby every time it cries is a
pernicious one, and no doubt the mother, who will be striving to
faithfully follow instructions, will have to overcome the advice of
meddling friends who will regard it as a cruelty to allow the baby to
cry. Do not give in to these busy-bodies; insist on attending to your
own affairs, but be absolutely sure baby is not crying for a just cause.
A child can only cry; that is its only language, but it cries for many
things other than the nipple or the bottle. Examine it carefully,--a wet
diaper a pin, an uncomfortable position, a drink of water, any of these
may be the cause.

It is just as essential that a child should cry as that it should sleep.
Every healthy child should cry for twenty or thirty minutes every
twenty-four hours. Nature calls for this as an exercise in order to
develop the lungs; therefore, if there is no just cause for the crying
you must regard it as a necessary evil, even if you look upon it as a
domestic affliction.

THE HABIT OF WALKING THE FLOOR WITH BABY EVERY TIME IT CRIES.--This is
another habit that is indulged in to the sorrow and ridicule of the
race. If you are a victim of this habit, you have yourself to blame. It
is a matter of education, or habit, pure and simple, and, like all bad
habits, it is difficult to break away from. In the preceding paragraph,
you have been told that when baby wants something, or is uncomfortable,
it employs the language nature gave it,--it cries. No child ever cried
to be walked up and down the floor in the dead of the night. Begin at
the beginning, when it first cries, find out why it is crying. Offer it
a little water if it is not feeding time. Examine its diaper and if
soiled change it. It may be overdressed and consequently hot,
perspiring, and uncomfortable; change its position. Find out if any pin
is open and hurting it; loosen the binder so it can breathe easily. If
it is a colicky child follow the instructions given in the treatment of
colic. Be patient the first few nights, and be thorough, because you may
discover why it cries and each discovery will help you next time. If you
discover something wrong, some reasonable excuse for the crying, does it
not prove the folly of walking the floor? If it wants a drink of water,
or if its diaper is wet, how is walking the floor going to cure it, or
how can you expect the baby to stop crying when you so unjustly construe
its reasonable and its only way of asking a favor? If walking the floor
stops its crying, it stops it by exhausting the child, not by relieving
it of its little ailment.

JOUNCING OR HOBBLING BABY.--This is another habit that should be frowned
upon. So many persons are addicted to this form of baby torture, that it
is astonishing more immediate harm does not result from it. Be
particularly careful not to indulge in it, or permit anyone else to do
it immediately after feeding. If you form the habit of putting baby down
at once after each feeding, as you have been instructed to do, the
opportunity to jounce it will not exist. A little reasoning will clearly
convince you that to subject a baby to violent exercise when its stomach
is full would interrupt digestion and so shake the full stomach hat it
would distend it and cause indigestion. You would not think of
exercising yourself after a meal; why exercise a baby?

BABY NEEDS WATER TO DRINK.--Boil a quantity of water each morning, put
in a clean bottle, and keep in a cool place. Give the baby some, three
or four times daily between feedings. One teaspoonful is enough to begin
with, and as it grows older it will take more. It may not always take
the water but it will take what it wants, and it needs some every day;
it is therefore your duty, inasmuch as baby cannot ask for it, to offer
it regularly each day as part of your daily routine.


KISSING

A child should never be kissed on the mouth by anyone, not even its own
parents.

Kissing should not be allowed among children. If any kissing is done it
should be on the brow, never on the mouth, hands, or fingers.

Many diseases are carried by this pernicious habit, and you cannot
afford to have baby's health jeopardized by this promiscuous and
unnecessary liberty.


ESTABLISHING TOILET HABITS

When baby reaches the age of three months, a regular systemized effort
should be made to educate it to "habits of cleanliness." Nothing can be
done in this direction previous to this age, as a child at that period
of its life is scarcely conscious of the natural functions of its body.
Each time a baby, after the third month, is making an effort to move its
bowels, the nurse or mother should go to it as it lies in its crib, and
talk to it by making a certain sound or say a certain word--whichever
word or words you want to educate your child to say, when it wants to
move its bowels. By constant attention and effort in this direction, a
child with quick perception and initiative will soon associate the sound
and the function, and it will begin to make the sound when the function
is about to be performed. As soon as it begins to make this sound, if
prior to the act of moving the bowels, the child should be immediately
taken up and held on a chamber, into which some hot water has been put,
and encouraged to relieve itself, the nurse or mother still repeating
the sound, or word, or words.

Having successfully accomplished this programme a number of times, the
child should be encouraged and petted every time it gives a satisfactory
warning, and discouraged and reproved every time it wets or soils its
napkin. A little later, say about six months, the child should be held
on the chamber at a certain time each morning and evening, thus
encouraging it to move its bowels regularly twice daily. The careful
carrying out of a scheme such as the above will establish regular,
cleanly habits, and will to a very large extent guard against
constipation in the future.

BABY'S COMFORTER.--The discovery and introduction of the comforter or
rubber teat was an unfortunate episode in someone's life. By the
careless, conscienceless nurse, or thoughtless mother, it is regarded as
a real comfort and blessing. Any temporary comfort, however, which the
nurse or mother may enjoy as a result of its use, is at the expense of
the health of the child. Its use is a serious reflection upon the good
intention and intelligence of the mother who permits her child to use
one. It is a bad habit from every viewpoint possible. In order that
mothers, open to conviction and capable of reasoning, may appreciate the
character of the harm done by the use of the comforter, we will briefly
record these conditions:

1st. The constant sucking pulls upon the delicate structures of the
mouth and throat, and so impairs the health tone of these structures
that they become flaccid and feebly nourished. This to a certain degree
causes adenoids, enlarged tonsils, loose palate and weak throat, with
the constant tendency to winter colds and coughs, and to catarrh.

2nd. It causes an excessive flow of saliva. Saliva should only be
stimulated previous to stomach digestion. By causing an excessive flow
of saliva into an empty stomach, the digestive powers are interfered
with, and seriously weakened. Stomach trouble, and consequently
intestinal disease, may therefore be caused by the seemingly innocent
comforter.

3rd. A constantly used comforter always causes disease of the mouth.
Mucous erosions, canker sores, little ulcers, etc., are produced in this
way.

4th. The use of the comforter makes it impossible to put the child to
sleep, or even to leave it alone, without first placing it in its mouth.

5th. To stifle a baby's cry, by pushing the comforter into its mouth, is
as bad as giving it chloroform to mask a serious and dangerous pain. If
may have a just reason for crying, as is explained elsewhere, and if
that reason is not searched for and found, it may mean serious trouble
later.

6th. Actual deformities of the mouth are produced by constant use of the
comforter. The continuous sucking affects the gums, pushes them out of
shape and position, and the teeth as a consequence come at wrong angles,
thus causing unsightly deformities, which last throughout the life of
the child.

7th. The worst fault of the comforter is to be found in its
uncleanliness. We are quite satisfied that the use of the comforter will
be legislated against one of these days. If preventive medicine means
anything, it must certainly reckon with the comforter in the very near
future. Have you ever watched your baby suck on its comforter? If you
have, you must have noted the tireless energy with which it works its
tiny jaws and tongue. Suddenly the comforter slips from the little mouth
and baby begins to cry, attracting the attention of the mother, or
nurse, or little sister, who promptly, recognizing the trouble, pounces
on the offending comforter, which has fallen to the floor, and with a
perfunctory wipe replaces it in baby's mouth. It is done just as we have
written it, many thousand times, and yet the problem of infant mortality
is represented as a vexatious mystery. The newspapers solicit charitable
aid, and write eloquent appeals regarding the necessity of sending a few
babies to the seashore in the summer time or to supply a few with ice
during the hot spells. A hundred other energetic enthusiasts send forth
their laudable effort to raise the standard of child hygiene, yet the
manufacturers of the comforter, and the ignorant mother and nurse who
use it, do more harm in one day than all the honest effort of these
combined forces can neutralize in a year.

The rubber comforter is one of the most fertile causes of infection and
illness in babies because of the peculiar adaptability to collecting
germs which it possesses.

When the comforter is finally discarded the habit of sucking is so
firmly established that the child will suck its thumb for many years
after. This results in further disease and deformity to the growing
mouth and throat, and also to the thumb.

After a child has used a pacifier or comforter for some time it
invariably becomes a mouth breather. A mouth-breathing child is very apt
to catch cold and as a consequence of the habit may become catarrhal or
tubercular.

WHAT CAN BE DONE TO LESSEN THE EVIL EFFECTS OF THE "COMFORTER"
HABIT?--It is a most difficult habit to cure when once established. The
very least that can be done is to keep the comforter scrupulously clean,
washing it several times daily. To have not one, but two or three, kept
in a saturated solution of boracic acid, ready to put into the baby's
mouth should one be required to replace another that has fallen out. We
should furnish a large shield to prevent it being swallowed. We can try
the method of weaning the baby from the comforter by tying a ribbon to
it and to the child's bodice. The system is gradually to shorten the
ribbon until it becomes too short for the baby to suck in comfort. It
will then gradually grow away from the habit.


FOOD FORMULAS

BEEF JUICE.--Take one pound of round steak and broil it slightly. Press
the juice out with a lemon squeezer, or, with a meat-press. Season with
salt and serve hot or cold as desired. If it is heated after it has once
been cold, it should not be overheated as this will coagulate the
albumen which will appear as flakes floating on the surface of the
juice.

BEEF JUICE BY THE COLD PROCESS.--Take one pound of finely chopped round
steak, six ounces of cold water, a pinch of salt; place in a covered jar
and stand on ice, or in a cool place, six hours. This mixture should be
shaken from time to time. Strain and squeeze all the juice out by
placing the meat in a coarse cloth and twisting it very hard. Season and
feed as above.

Beef juice made in this way is more nutritious than that made from the
steak when broiled; it is not, however, quite so palatable.

Beef juice made in either of the above ways is much more nutritious than
the beef extracts sold ready to use.

MUTTON BROTH.--Take one pound of finely chopped lean mutton, including
some of the bone, one pint of cold water and a pinch of salt, cook for
three hours over a slow fire down to half a pint, adding water to make
up this quantity if necessary; strain through muslin. When it is cold
remove the fat and add more salt if required. It may be fed warm or cold
in the form of a jelly.

MUTTON BROTH WITH CORNSTARCH OR ARROWROOT.--Add to the above sufficient
cornstarch or arrowroot to thicken, cook for ten minutes and then add
three ounces of milk, or one ounce of thick cream, to a half pint of
broth. This makes a nutritious and extremely palatable broth.

CHICKEN, VEAL, AND BEEF BROTHS.--These may be made and used in the same
way as mutton broth.

SCRAPED BEEF OR MEAT PULP.--Take a rare piece of round or sirloin steak,
cut the outer part away, scrape or shred with a blunt knife. Cutting the
meat into small pieces is not satisfactory. One teaspoonful to one
tablespoonful may be given well salted, to a child a year and a half
old. It is best to begin with a small dose and work up to the larger to
accustom the digestive apparatus to its use.

JUNKET, OR CURDS AND WHEY.--Take one pint of warm fresh cow's milk, a
pinch of salt, a teaspoonful of granulated sugar, to which add two
teaspoonfuls of Fairchild's essence of pepsin and allow the mixture to
stand until firmly coagulated--this may take about twenty minutes--place
in the ice box until thoroughly cold. Nutmeg may be added for older
children and adults.

WHEY.--The coagulated milk prepared as above is broken up with a fork
and the whey is strained off through cheesecloth. If a stimulant is
desired, brandy, in the proportion of one teaspoonful to six
tablespoonfuls of the whey may be added.

BARLEY WATER.--One level tablespoonful of Robinson's barley is rubbed up
with a little cold water, to this is added one pint of boiled water
containing a pinch of salt. The mixture should be stirred while the
water is being added. Cook for thirty minutes in a double boiler and
strain. Enough boiling water should be added to the mixture to make up
the full pint if any has boiled away.

BARLEY GRUEL OR BARLEY JELLY.--Repeat the above process, but instead of
using one tablespoonful of the barley powder, use from two to four
according to the consistency of the gruel or jelly desired.

Barley water may be made from the grains. A formula for this process
will be found in the chapter on artificial feeding.

RICE, WHEAT, OR OAT WATER.--These are made from the rice, wheat, or oat
flour in the same way as barley water described above. They may be made
from the grains also, using the same proportions as in the making of
barley water.

IMPERIAL GRANUM.--This is prepared in the same way as the barley flour
above described.

ALBUMEN WATER.--Take half a pint of cold water, the white of one fresh
egg, a pinch of salt, and a teaspoonful of brandy, shake and feed from a
spoon or from a bottle. This is frequently used in cases of vomiting, or
in irritable stomachs. It is often retained when all other food is
rejected.

DRIED BREAD.--Cut either stale or fresh bread into thin slices and place
in the open oven. When it is dried and crisp but not browned it may be
given to children in preference to crackers.

CODDLED EGG.--A fresh egg with the shell intact is placed in boiling
water which is immediately removed from the fire. The egg is allowed to
remain in the water for eight minutes when it is ready for use. The
white only should be used if the digestion is poor.




ARTIFICIAL FEEDING




CHAPTER XIX

ARTIFICIAL FEEDING

     Elementary Principles of Milk Modification--The Secret of the
     Efficiency of Mother's Milk--Two Important Factors in
     Successful Artificial Feeding--Every Child is a Problem in
     Itself--Proprietary Foods of Little Value as Infant
     Foods--Their Value is in the Milk Added to Them--The Credit
     Belongs to the Cow--Difference Between Human and Cow's
     Milk--What "Top-milk Feeding" Means--Utensils Necessary for
     Home Modification of Milk--Artificial Feeding from Birth to the
     Twelfth Month--How to Measure Top-milk--Easy Bottle-feeding
     Method--Condensed Milk Feeding--Objections to Condensed Milk
     Feeding.


ELEMENTARY PRINCIPLES OF MILK MODIFICATION.--Mothers who have to raise
their children on artificial food should understand the elementary
principles of milk modification. They should know, for example, that the
one object of milk modification is to render it as nearly an exact
substitute for mother's milk, according to the age of the child, as is
possible. If we could do this with scientific exactness, artificial
feeding would be a simple process. We cannot, however; nor has there
ever been devised a method by which we may hope successfully to
duplicate mother's milk. It is a comparatively simple matter for the
efficient chemist to analyze the breast milk of any nursing mother; and
it is quite possible to duplicate the milk according to the analysis,
with chemical exactness, but the two fluids will not be the same. There
is present in the mother's milk something which synthetic chemistry
cannot discover. This something is nature's secret,--it is akin to the
life-giving principle which is contained in the germinal fluid, and in
the hen's egg. We cannot therefore hope to build up an artificial food
that contains this mysterious life-giving principle which is the secret
of the efficiency of maternal milk,--we can only hope to approximate
it. It is possible that we might be successful so far as its nursing
efficiency is concerned, if all children were alike, if all children
were of a uniform standard of health. As a matter of fact, no two babies
are exactly alike. And while the mother of each child undoubtedly
secretes a milk suitable to the degree of healthfulness of her own
child, the same milk might not be equally suitable to another child. The
milk, therefore, that is manufactured to agree with an average mother's
milk is dependent for its success upon the vitality of the child to
which it is fed. If that child is not a well child, according to an
accepted standard, the milk will not agree with it, even though it is
the best possible substitute for an average breast milk.

We have consequently two factors to consider in successful or efficient
artificial feeding:

    1. Our inability to duplicate exactly mother's milk.
    2. The lack of a uniform health standard in children.

It is the lack of a uniform health standard in children that gives to
artificial feeding all its difficulties. It renders the successful
artificial feeding of children a personal or individual problem. Some
children,--those who approximate a standard of health for their age; in
other words, "well" children,--thrive on a milk modification that
experience has taught us is suitable for well children of their age.
Others, and they are in the majority, have to be fed on a modification
which actual test proves to agree with their digestive capabilities.
Every artificially fed child therefore must be studied from its own
individual standpoint. A certain modification of milk may not agree with
a child fed every two and one-half hours, which will be found to agree
if fed in the same quantity, to the same child, every three hours. The
slightest change, a change which would seem to be so insignificant in
itself as not to justify serious consideration, may mean the difference
between normal healthfulness and constant ill health. A food that is too
strong for a child's digestive ability, and which causes vomiting,
colic, and diarrhea, may be rendered exactly right by the slightest
modification one of its constituents. To effect such a change quickly
and successfully, one must be trained to interpret the symptoms
correctly and to know how to make the change in the modification of the
milk. Mothers cannot be expected to possess this degree of skill: they
should therefore refrain from experimenting, because an experiment on a
baby is not only dangerous, but ethically it is criminal. Call the
family physician; put the burden on his shoulder.

It is this element of uncertainty in our ability to effect a standard
modification of milk that has afforded manufacturers the rich
opportunity of putting on the market various baby foods for which much
is claimed. These foods are really substitutes for the inefficiency of
the average mother. There is no real justification for their use. If all
mothers were clean, faithful, and efficient, there is no reason why each
one could not be taught to modify cow's milk to suit her child, just as
satisfactorily, or more so, than a manufacturer who never saw her child.
The manufacturers, however, do the work, and the naturally ignorant or
lazy and inefficient mother, is willing to pay for the extra cost of
labor, to save herself the trouble on the one hand, and to subject her
child to a series of experiments in order to discover the manufactured
food that is particularly adapted to her particular baby on the other
hand. We believe that most mothers have never considered the question
from this standpoint; that most mothers adopt this method of artificial
feeding at the direct suggestion of their family physician, and are not,
therefore, responsible. These foods do not contain the nutritional
elements necessary to healthy growth; or as they exist in normal breast
milk; or as they can be approximated in ordinary milk modification at
home. Proprietary foods are of decidedly poor value in infant nutrition,
and should not be used. They have a value, however, in certain diseased
conditions, but within a very small range. As a food for a healthy
growing infant, they should not be used, and when the average physician
appreciates this fact, and so instructs the mothers of the country, it
will be to the distinct advantage of the race in every respect.
Proprietary foods to which fresh cow's milk is added, are not foods at
all,--they depend upon the milk so far as any nutritional value is
concerned; and it would be far safer to modify at home a good milk than
to buy a proprietary food, the analysis of which cannot be depended
upon. The credit for the fat, healthy babies we see advertised does not
belong to the manufacturers, but to the cow whose milk you add to the
manufacturer's sugar.

The proprietary beef foods are also valueless as infant foods. In
certain illnesses, when we want a mild stimulant, a teaspoonful or two
in hot water may have a certain value, but that is all. The beef juice
of home manufacture is much more valuable.

DIFFERENCE BETWEEN HUMAN AND COW'S MILK.--The composition of cow's milk
is as follows:

    Fat (represented by cream)        4%
    Sugar                             4%
    Proteids (represented by curd)    4%

The composition of an average human breast milk is as follows:

    Fat              4%
    Sugar            7%
    Proteids     1-1/2%

It will be observed from a comparison of the above tables that cow's
milk is much richer in proteids (the substances which form with water
the curd of sour milk) than is human milk. If one remembers that cow's
milk is manufactured by nature primarily for the feeding of calves, not
for babies, and that the stomach of a calf is intended to exist
exclusively on vegetable products, and that nature is preparing it for
this purpose, and feeds it a food when young that will enable it to grow
so as to be adapted for that purpose, one can understand that the
problem of the modification of cow's milk to suit the stomach of a baby
is not by any means a simple matter. Since the proteids are so much in
excess in cow's milk, we must dilute cow's milk with twice its bulk or
more of water to render it fit food for a new born baby. If we dilute
cow's milk to this extent to get the proteid percentage right, we
immediately disarrange the percentage of the cream or fat. We overcome
this difficulty by taking the cream from the top of the bottle and
diluting it because it is richer in fat and does not need so much
dilution. This is the explanation of the so-called "top-milk feeding."
The percentage of sugar represents another problem. The percentage of
sugar in cow's milk compared with the sugar in human milk is deficient,
so we add milk-sugar to the cow's milk to make up the deficient
percentage.

There is yet another feature which we must rectify; cow's milk is acid,
while human milk is alkaline. To overcome this difference we add
lime-water. We must also take into consideration that cow's milk is
ordinarily full of germs, while human milk is free from them; to
overcome this danger we resort to heating the milk to a degree which
experience has taught us will kill all germs. Cooked milk is not as
wholesome as uncooked milk, and it has a tendency to cause constipation.
We have to a certain extent overcome the need for cooking all milk for
babies, as will be noted later, but in summer time, unless the milk is
known to be pure and free from germs, it is advisable to sterilize it.


UTENSILS NECESSARY FOR HOME MODIFICATION OF MILK

    One dozen round, eight-ounce nursing bottles.
    One dozen black rubber nipples.
    One eight-ounce measuring glass or graduate.
    One brush for cleaning bottles.
    One two-quart glass preserve jar for mixing the various ingredients.
    One one-ounce Chapin dipper, for removing the top-milk.
    One glass funnel.

A detailed description of the proper kinds of bottles and nipples will
be found elsewhere. The measuring glass or graduate should be
wide-mouthed. It is not safe to spoon the top-milk off, nor is it safe
to pour it out. Absorbent cotton should be provided to close the nursing
bottles when filled and left standing in the ice box.


ARTIFICIAL FEEDING FROM BIRTH TO THE TWELFTH MONTH

The following formulas for the different ages may be found useful for
well babies:


From the third to the tenth day:

    Milk (top 16 oz.)                3 ounces.
    Lime-water                     1/2 ounce.
    Milk-sugar                       1 ounce.
    Boiled water to make            16 ounces.

Ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each feeding.


From the tenth to the twenty-first day:

    Milk (top 16 oz.)           6 ounces.
    Lime-water              1-1/2 ounces.
    Milk-sugar              1-1/2 ounces.
    Water to make              24 ounces.

Nine to ten feedings in twenty-four hours; 1-1/2 to 2 ounces at each
feeding.


From third to the sixth week:

    Milk (top 16 oz.)       10 ounces.
    Lime-water           2-1/2 ounces.
    Milk-sugar               2 ounces.
    Water to make           32 ounces.

Eight to nine feedings in twenty-four hours; 2 or 3 ounces at each
feeding.


From sixth week to the third month:

    Milk (top 16 oz.)    12 ounces.
    Milk-sugar            2 ounces.
    Lime-water            3 ounces.
    Water to make        32 ounces.

Seven to eight feedings in twenty-four hours; 2-1/2 to 4 ounces at each
feeding.


From third to fifth month:

After this age two bottles of milk are required, 16 ounces being taken
from the top of each bottle and mixed.

    Milk (top 16 oz.)     18 ounces.
    Milk-sugar             2 ounces.
    Lime-water             4 ounces.
    Water to make         40 ounces.

Six feedings in twenty-four hours; 4 to 5 ounces at each feeding.


From the fifth to the seventh month:

    Milk (top 16 oz.)      21 ounces.
    Milk-sugar              2 ounces.
    Lime-water              5 ounces.
    Water to make          42 ounces.

Six feedings in twenty-four hours; 5 to 7 ounces at each feeding.


From the seventh to the ninth month:

    Milk (top 16 oz.)       27 ounces.
    Milk-sugar           2-1/2 ounces.
    Lime-water               6 ounces.
    Water to make           48 ounces.

Five to seven feedings in twenty-four hours; 6 to 8 ounces at each
feeding.


From the ninth to the twelfth month:

    Milk (top 16 oz.)            35 ounces.
    Milk-sugar                2-1/2 ounces.
    Lime-water                    6 ounces.
    Water to make                56 ounces.

Five to six feedings in twenty-four hours; 7 to 9 ounces at each
feeding.

It will be observed that 16 ounces of top-milk is used to make the
various formulas from. This means that the mother will dip off, with a
Chapin dipper, 16 ounces from the top of a bottle of milk which has
stood for four or five hours to allow the cream to rise; she will then
mix this and take from the mixture the number of ounces called for in
the formula she is using according to the age of the child. The ordinary
milk that is delivered in New York City may be assumed to have stood the
four or five hours necessary. This may not be so, however, in the
country, as it is frequently delivered there as soon as it is milked. In
such cases the mother will permit it to stand in the ice box until the
cream has risen.

When the mother is about to make the mixture called for in feeding from
the third to the fifth month she will observe that 18 ounces of milk is
called for. Now since she only uses 16 ounces of the top-milk from one
bottle this will not be enough. She must therefore use 16 ounces from
two bottles of milk; this she will mix together and from this mixture
she will take the 18 ounces wanted. Whatever milk is left over may be
used for ordinary table purposes.


EASY BOTTLE-FEEDING METHOD

The following formulas and instructions for bottle-feeding are taken
from the Rules for the Care of Infants and Young Children which are used
by Dr. Kerley at the out-patient department of the Babies' Hospital and
give the simplest and easiest means of bottle-feeding:

     BOTTLE-FEEDING.--The bottle should be thoroughly cleansed with
     borax and hot water (one teaspoonful of borax to a pint of
     water) and boil before using. The nipple should be turned
     inside out, scrubbed with a brush, using hot borax water. The
     brush should be used for no other purpose. The bottle and
     nipple should rest in plain boiled water until wanted. Never
     use grocery milk. Use only bottled milk which is delivered
     every morning. From May 1st to October 1st the milk should be
     boiled five minutes immediately after receiving. Children of
     the same age vary greatly as to the strength and amount of food
     required. A mixture, when prepared, should be put in a covered
     glass fruit-jar and kept on the ice. For the average baby the
     following mixture will be found useful:

     "For a child under six weeks of age: Nine ounces of milk,
     twenty-seven ounces of barley-water, four teaspoonfuls of
     granulated sugar. Feed from two to three ounces at two and
     one-quarter hour intervals, nine feedings in twenty-four hours.

     "Sixth to the twelfth week: Twelve ounces milk, twenty-four
     ounces barley-water, five teaspoonfuls sugar. Feed from three
     to four ounces at each feeding.

     "Third to the sixth month: Eighteen ounces of milk, thirty
     ounces of barley-water, six teaspoonfuls of sugar. Feed four to
     six ounces at three-hour intervals, seven feedings in
     twenty-four hours.

     "Sixth to the ninth month: Twenty-four ounces milk, twenty-four
     ounces barley-water, six teaspoonfuls granulated sugar. Feed
     six to eight ounces at three-hour intervals, six feedings in
     twenty-four hours.

     "Ninth to twelfth month: Thirty-eight ounces milk, twelve
     ounces barley-water, six teaspoonfuls of granulated sugar. Feed
     seven to nine ounces at three and one-half hour intervals, five
     feedings in twenty-four hours."

BARLEY-WATER.--The barley-water used in the above formulas may be made
in the following way: To two teaspoonfuls of pearl barley, add one quart
of water, and boil continuously for six hours, keeping the quantity up
to a quart by the addition of water; strain through coarse muslin. The
barley will be better if it is soaked for a number of hours, or over
night, before cooking. The water in which it is soaked is not used.

An equally good barley-water may be made in an easier way by using
Robinson's prepared barley. This may be procured in the drug stores. It
is only necessary to take one even tablespoonful of this barley to
twelve ounces of water and cook for twenty minutes.

CONDENSED MILK.--When the mother cannot afford to buy bottled milk from
the wagon, when she has no ice-chest and cannot afford to buy ice, she
should not attempt cow's-milk feeding, but may use canned condensed milk
as a substitute during the hot months only. The can, when opened, should
be kept in the coolest place in the apartment, carefully wrapped in
clean white paper or in a clean towel. The feeding hours are the same as
for fresh cow's milk:

"Under three months of age: Condensed milk one-half to one teaspoonful;
barley-water, two to four ounces.

"Third to sixth month: Condensed milk, one to two teaspoonfuls;
barley-water, four to six ounces.

"Sixth to ninth month: Condensed milk, two to three teaspoonfuls;
barley-water, six to eight ounces.

"Ninth to twelfth month: Condensed milk, three teaspoonfuls;
barley-water, eight to nine ounces."

OBJECTIONS TO CONDENSED MILK FEEDING.--Condensed milk is not to be
recommended as a permanent food where good cow's milk can be obtained.
In most cases it should be used as the sole food for a few weeks only.
It may be used when the digestion is impaired for some reason. If the
symptoms are intestinal it will be more apt to agree than if they are
caused by stomach ailments. The symptoms of intestinal disturbances
are,--colic, flatulence (gas), curds or specks in the stools,
constipation or diarrhea. It will not be found suitable if the child is
simply vomiting.

The objections to condensed milk are: It is very rich in sugar and very
deficient in proteids and fat. Children fed on condensed milk often gain
very rapidly in weight but have little strength or resistance. They do
not fight disease well for this reason; they are apt to develop rickets
and scurvy.




CHAPTER XX

ARTIFICIAL FEEDING--CONTINUED

     How to Prepare Milk Mixtures--Sterilizing the Food for the
     Day's Feeding--How to Test the Temperature of the Food for
     Baby--When to Increase the Quality or Quantity of Food--Food
     Allowable During the First Year in Addition to Milk--Beef
     Juice--White of Egg--Orange Juice--Peptonized Milk--The Hot or
     Immediate Process--The Cold Process--Partially Peptonized
     Milk--Completely Peptonized Milk--Uses of Peptonized
     Milk--Objections to Peptonized Milk--What a Mother Should Know
     About Baby's Feeding Bottle and Nipple--Should a Mother Put Her
     Baby on Artificial Food if Her Supply of Milk, During the First
     Two Weeks is not Quite Enough to Satisfy it--Certain Conditions
     Justify the Adoption of Artificial Feeding from the
     Beginning--Mothers' Mistakes in the Preparation of Artificial
     Food--Feeding During the Second Year--Sample Meals for a Child
     Three Years of Age--The Diet of Older Children--Meats,
     Vegetables, Cereals, Bread, Desserts--Fruits.


HOW TO PREPARE MILK MIXTURES

The mother should always remember, that the secret of success in raising
a baby efficiently on artificial food is to be cleanly and to be exact.
The bottles and the nipples must be scrupulously clean; the hands of the
mother must be clean; the water used must be boiled and each ingredient
must be measured exactly.

First dissolve the sugar in the boiled water, which must be the exact
quantity; then remove the top-milk and measure the exact amount wanted
in the graduate, pour into the jar, add the water and sugar mixture, and
finally the lime water.

It is always desirable to make the entire quantity for the day at one
time. After the total quantity has been mixed in the jar, fill each
bottle with the amount for each feeding, put in a cotton stopper, and
place the bottles in the ice box.

In measuring the sugar, it should be remembered that two scant
dipperfuls equal one ounce by weight of the sugar.

When each individual bottle is to be filled, do it with the aid of the
glass funnel which has been previously sterilized.

STERILIZING THE FOOD FOR THE DAY'S FEEDING.--The simplest method is to
place the two-quart jar containing the milk mixture for the next
twenty-four hours' feeding upon a saucer in the bottom of an open pan,
and then to pour enough tepid water into the pan (outside of the jar)
until it will come up as high as the milk level. The water in the pan is
then brought slowly to the boiling point. The pan is then moved to the
back of the stove and left for half an hour. The jar is then removed and
rapidly cooled by allowing cool water to flow over the outside; the
individual bottles filled and put in the ice box.

It is always wise to taste the milk before making up the day's feeding
to be sure it is not sour. The milk from a herd of good cows is always
better than the milk from one cow no matter how good that one cow may
be.

When about to feed the baby, the bottle is taken out of the ice box and
heated to the desired temperature in a water bath. The temperature of
the milk can be tested by allowing a few drops to fall on the wrist; it
should feel warm, not hot; it should not be tasted by putting the bottle
to the mouth of the nurse, or mother, as it may become infected by doing
so. A flannel cover, or bag, should be made to fit the bottle and it
should be put on while the baby is nursing so that the milk may retain
its heat. The baby must not be disturbed while nursing, nor should he be
jounced or carried around after nursing. These habits cause vomiting and
indigestion. He should be put in his crib.

WHEN TO INCREASE THE QUALITY OR QUANTITY OF FOOD.--Children of the same
age may have different digestive abilities. A strong, robust child may
be permitted to take a richer quality of milk than a weak, puny infant
of the same age. If the quality or quantity of each feeding is too weak
or small for the baby he will be dissatisfied and he will cry after the
feeding. In such cases, if the bowel discharges are natural and yellow
without curds or white specks, and if he is not gaining sufficiently in
weight, the next stronger formula may be tried. If it is decided to put
him on the stronger mixture, it is wise to cut the quantity down for a
day or two in order to test out his digestive ability. If the stools
remain good after three days, the quantity may be slowly increased until
the amount in the recipe is allowed. It is a much more serious risk to
overfeed the baby than to underfeed him. If too large a quantity is
given, he may vomit it at once, or he may develop colic with intestinal
indigestion. Such babies lose weight, become fretful and irritable, even
though the appetite may remain good. If too strong a quality is given he
may vomit sour, buttery-smelling milk, or have colic, and pass curds in
the stool. If this happens it may be necessary to go back to a weak
formula and work up from that standard. This is always a tedious and
anxious experience and may lay the foundation for digestive disturbances
for a long time. Don't be too anxious to increase the quality, or
quantity, of your baby's food. It is much better to go slow and have a
well baby, than to try to force matters and get into all kinds of
trouble. No science calls for more elementary common sense, than the
science of infant therapy.

Digestive disturbances incident to this period are fully explained in
the chapter on Diseases of Children.


FOOD ALLOWABLE DURING THE FIRST YEAR, IN ADDITION TO MILK

About the twelfth month the baby should receive plain milk mixtures
instead of the top-milk heretofore used in making up the food. At first
the milk may be plain milk from an ordinary bottle shaken up. Of this he
may take five ounces, to which may be added three ounces of barley
water. The barley water may be gradually withdrawn, an ounce at a time,
replacing this amount with milk, until the child is taking eight ounces
of milk and two ounces of barley water. Later plain mixed milk will be
suitable for a child about the fourteenth month.

Barley water may be added to the milk at any time after the third month
in place of the plain boiled water in the preceding formulas. It is
advisable to do this if there is any trouble with digestion, or if there
are curds in the stools. Some children take more kindly to barley water
than plain water at a very early age.

BEEF JUICE.--The juice squeezed from broiled steak may be given a child
at about the eighth or ninth month, or, in cases of anemia, earlier than
this. It is given before the milk feeding, diluted with an equal amount
of water. At first a teaspoonful of the extracted juice should be given
with the same quantity of water; increase every four days until at the
end of two or three weeks two tablespoonfuls are given.

WHITE OF EGG.--Place an egg in boiling water and allow the water to cool
with an egg in it. In ten minutes the white of the egg will be
coagulated and ready for use. It may be used in place of the beef juice
if the latter does not agree and may be begun at the sixth month and
given once daily. One-half of the white of the egg should be tried, then
at the end of a week, if it agrees with the child, the whole white of
one egg may be given.

ORANGE JUICE.--This juice has a good effect on the bowels and may be
given even to very young children who are disposed to be constipated. It
is also of benefit in counteracting the effect of boiled milk. The juice
should be extracted from fresh oranges and strained. One teaspoonful may
be given at first one hour before a feeding. The amount may be increased
until four teaspoonfuls, or one tablespoonful, are given daily.

PEPTONIZED MILK.--The object of peptonization of milk is partly or
wholly to digest the casein, or curd, of the milk before feeding.

Fairchild's Peptonizing Powder is used for this purpose. The powder is
put up in tubes, and instructions are furnished in each box as to its
use.

There are two methods of using the powders:

THE HOT OR IMMEDIATE PROCESS.--Fifteen minutes before feeding add from
one-eighth to one-quarter of the contents of a tube to the milk mixture
in the nursing bottle ready for use. The bottle is then put in water at
a temperature of from 110° to 120° F., and allowed to remain in the
water for fifteen minutes. The amount of the powder used and the
temperature of the water depend upon the amount of milk in the nursing
bottle.

THE COLD PROCESS.--Four ounces of cold water are put into a clean quart
bottle and the powder from one of the tubes. Shake the mixture
thoroughly until the powder is dissolved. Add a pint of cold fresh milk,
shake the bottle again and place directly on ice. When any of this milk
is used the bottle should be again shaken and put immediately back on
ice.

If necessary this process may be modified so that partially or
completely peptonized milk may be made.

PARTIALLY PEPTONIZED MILK.--Put four ounces of water and a whole tube of
powder into a clean pan and stir well; add a pint of cold milk and heat
to the boiling point, stirring the mixture all the time. There should be
enough heat to bring the milk to the boiling point in ten minutes. Allow
the mixture to cool somewhat and strain into a clean jar, cork tightly
and keep in a cool place. Shake the jar before and after using any of
the contents.

If partially peptonized milk is properly prepared it should not become
bitter.

COMPLETELY PEPTONIZED MILK.--Put four ounces of cold water and the
powder contained in one of the tubes into a clean quart bottle and shake
thoroughly. Add a pint of cold fresh milk and shake again; then place
the bottle in a pan of warm water about 115° F., or not too hot to place
the hand in comfortably. Keep the bottle in the water bath for thirty
minutes; then place the bottle directly on ice.

USES OF PEPTONIZED MILK.--Partially peptonized milk is useful in young
infants who have difficulty in digesting the curd of milk. Completely
peptonized milk is frequently used during attacks of indigestion. It is
used also to tide a delicate infant over a period when for some reason
the digestive apparatus refuses to digest and assimilate even dilute
mixtures. It is of value also in acute or chronic illness when the child
has to be fed through a tube. When it is necessary to feed per rectum
peptonized foods are often selected in preference to others.

OBJECTIONS TO PEPTONIZED MILK.--Complete peptonization of milk renders
the milk bitter. For this reason many children will not take it. Very
young children whose sense of taste is not developed may be induced to
take it after a few days. It is not wise to continue its use long
because the function of the stomach will become accustomed to the use of
predigested food and refuse to work when called upon. If it is used for
a number of weeks it is wise to stop it gradually in order to permit the
stomach to resume its function in a normal way.

WHAT A MOTHER SHOULD KNOW ABOUT BABY'S FEEDING BOTTLE AND NIPPLE.--In
the first place, always buy round bottles,--round everywhere, inside and
out,--there should be no corners anywhere. The reason for this is, that
bottles that are round everywhere, are easily cleaned, and can be
thoroughly cleaned, and having no corners they do not lend themselves to
collecting dirt and bacteria. When these bottles are first bought they
should be boiled. After each feeding they should be thoroughly washed
with soap or washing powder. A long-handled bottle brush should be used
to help clean the bottle. After the bottle has been thoroughly rinsed a
number of times with hot water, it should be set aside filled with warm
water into which one teaspoonful of bicarbonate of soda has been put.
Before filling them with the freshly prepared food each morning the
bottles should be boiled. Every mother with a bottle-fed baby should buy
a dozen bottles, all of the same kind and size to begin with. This is a
great advantage for a number of important reasons, two or three of which
I will mention:

1st. Having enough bottles means that each bottle will be used once only
during the twenty-four hours; there is less chance therefore of a bottle
being cleaned carelessly.

2nd. Having a fresh bottle for each feeding permits all of the food for
twenty-four hours being made at one time. This ensures uniformity of
quality of each feeding.

3rd. By cleaning all the bottles at one time (previous to filling) it is
more apt to be done thoroughly; and by making all the food for a day at
one time it is more apt to be correct than if each feeding was made
separately.

The baby's nipple should be made of plain black rubber. It should not be
too thick because it is necessary to turn it inside out in order to
clean it thoroughly. The hole in the nipple should not be too large--if
the child can empty the bottle in less time than fifteen minutes the
hole is too large. If the milk drops out but does not run it is about
right. Don't buy nipples too long or too large. A long nipple tends to
gag the child and cause vomiting. A large nipple prevents the child from
sucking properly and usually allows the food to be taken too quickly and
with air, which causes colic and indigestion. It is well to have always
half a dozen nipples of the right kind on hand. When new, nipples should
be boiled before using. After each feeding the nipple should be washed
in borax and water on both sides, then it should be put in a dish
containing fresh, cold, borax water and left there until again required.
A large portion of the success of raising healthy, bottle-fed babies is
in being everlastingly clean in the details of caring for the bottles
and nipples which are in daily use.

SHOULD A MOTHER PUT HER BABY ON ARTIFICIAL FOOD IF HER SUPPLY OF MILK,
DURING THE FIRST TWO WEEKS, IS NOT QUITE ENOUGH TO SATISFY IT?--This is
a question that cannot be answered by a simple yes or no. A great deal
depends upon circumstances, and these circumstances must be weighed and
counterweighed before an answer is given. It is a serious matter, in our
judgment it is a criminal proceeding for a physician to advise the use
of an artificial food without exhausting every aid and means to preserve
and increase the mother's milk. This is a subject in need of earnest
missionaries in all walks of life, and it should be the duty of every
woman's club and gathering to voice the conviction of the highest
womanhood by advocating the use of mother's milk with every child born.
A woman who can and will not nurse her own child is scarcely deserving
of the name of mother.

It does not seem quite human to deprive a baby of the milk which
rightfully belongs to it; yet in certain walks of life this is not an
uncommon procedure. On the other hand the percentage of women able to
nurse their children is decreasing. This is especially true as applied
to cities, though it is also true, in a less degree, in the rural
districts. One eminent authority states that less than twenty-five per
cent. of the well-to-do mothers, who have earnestly and intelligently
attempted to nurse their babies, succeed in doing so for a period longer
than three months. This authority also says: "An intellectual city
mother who is able to nurse her child successfully for the entire first
year is almost a phenomenon." Women nowadays have so many diversified
interests, that the primal duty of maternal nursing is not at all a
fashionable function. If, however, the mother is willing, and has
conscientiously tried to nurse her baby, and after seven or eight days
it is found that she has not enough milk to satisfy it, and if the
quality seems to be good, some expedient should be immediately adopted
to tide the condition over until the mother resumes her customary
household routine. The safest expedient under these circumstances is to
alternate the feedings; one feeding from both breasts of the mother, and
the next an artificial food. Some arrangement of this kind is the just
and the safest way, because a very large percentage of mothers suffer
from inactivity while lying in bed after a confinement. This inactivity
expresses itself in a failure of some of the organs to perform their
duty properly. This may affect the quantity, and sometimes the quality,
of the milk, but it is, as a rule, quickly rectified as soon as the
mother is up and active.

If, however, the milk is still found to be inadequate after she is up
and has resumed her usual habits, and if her health is good, and she is
eating well, it is distinctly best to put the child exclusively on an
artificial diet.


CERTAIN CONDITIONS JUSTIFY THE ADOPTION OF ARTIFICIAL FEEDING FROM THE
BEGINNING

1st. Woman suffering with any wasting disease such a cancer or
tuberculosis. (One of these days, and very soon we hope, it will be
legally impossible for a tubercular or cancerous patient to become a
mother.)

2nd. When a mother is the victim of any of the serious childbed
complications such as convulsions, kidney disease, extensive loss of
blood or blood poisoning, or runs a high temperature because of some
disease occurring at the same time as the confinement, as, for example,
appendicitis, scarlet fever, typhoid fever, etc.

3rd. Epilepsy, chorea, insanity, are also conditions which render
artificial feeding necessary.

It is much wiser immediately to put the child on artificial feeding if
there is a justifiable reason for it than to experiment, because any
experiment at this time is almost certain not to be in favor of the
child. Artificial feeding is a comparatively easy and successful
problem, provided it is begun with healthy digestive organs. If you keep
the child at the breast of a mother whose milk is inadequate in quantity
or quality, or both, for two or three days, and then begin artificial
feeding, the child's stomach is already unable to perform its duty, and
you have to treat it with the greatest degree of care and attention, and
probably begin with a weak food, until you regain the lost ground.

MOTHERS' MISTAKES IN THE PREPARATION OF ARTIFICIAL FOOD.--Another
interesting condition which is quite common, is the tendency on the part
of the mother to fail to follow instructions correctly,--even though
written or printed,--regarding the preparation of the baby's food. When
the baby is not thriving and gaining steadily in weight, or is fretty
and cries a good deal, and does not rest and sleep peacefully,
something, of course, is wrong. If, after a careful physical examination
of the child, nothing is found to justify these symptoms, a physician
invariably finds, if he questions the mother closely, that she has
mistaken the instructions and is preparing the food wrongly.

Infinite care in every little detail is the price of success in raising
babies as well as in every other field of human endeavor. Revise
carefully your method of preparing baby's food if there is any trouble
such as is described above. Despite your absolute assurance that you are
making no mistake, do not be surprised to find that you are not
following directions to the letter, and because of this unintentional
mistake, your negligence is responsible for your baby's condition. Go
over the instructions with your husband, and let him follow your method
of preparation, as you repeat it. He may detect the mistake if any
exists,--two heads are always better than one. So important is this
matter that the following two actual cases will demonstrate how easy it
is to make a mistake, despite the absolute confidence of the mother, in
each case, that she was following the printed directions correctly:

I was called to see a baby whose mother informed me that it was having a
great deal of trouble. It was apparently not thriving; its bowels were
bad; it constantly cried, and seemed to be suffering from colic and
indigestion. The mother stated that it lay with its legs constantly
drawn up and passed enormous quantities of gas. The baby certainly
looked sick. It had been a small baby at birth; and at three months it
weighed only six pounds. After a careful examination, I could find
nothing in the physical condition of the child itself, which
satisfactorily explained the condition, and had made up my mind that the
food upon which it was being exclusively fed, and upon which it had been
fed since birth, was not agreeing with it. Before recommending a change
of food, I asked the mother to state in detail just how she prepared it.

The directions printed on the can in which the food was bought called
for so many ounces of a certain quality of "top milk." She thought this
meant simply so many ounces off the top of a bottle of milk, which, of
course, meant that she was feeding her baby exclusively a very rich
cream and absolutely no milk. The result was that the baby--small and
weak to begin with--could not digest this rich mixture, so it gradually
lost vitality, as the mother kept increasing the strength of the food,
according to the age, as directed by the instructions, until it was
completely knocked out. I pointed out her mistake and suggested a change
in her methods; she was instructed to use the formula for a child of two
months, instead of the one for three months, as she was doing. The child
immediately began to pick up and in the course of six weeks was entirely
cured, and had gained considerably in weight. This mother was a
careful, clean, painstaking, attentive nurse, and it was a long time
before she forgave herself for the mistake. The mistake here was a
little matter, but the results were big and convincing.

The second case was that of a child of about the same age, but in this
instance it had been a robust, healthy child when born, and of normal
weight and size. The mother nursed it for about one month, when her milk
failed, and it was put upon a well-known, patent barley preparation. The
food seemed to agree with it for a time, but, as the mother explained,
the child soon seemed to be dissatisfied at each feeding,--it gave her
the impression that it was not getting enough to eat, so she increased
the quantity. Despite this increase of food, it was apparent that the
baby was getting weaker, and more and more irritable, and sleepless,
until there was no rest night or day for the mother or baby. About this
time the child began to "swell up" as if dropsical; it lost its healthy
color and looked as if made of wax. It was very evident that the child
was being starved, yet this scarcely seemed probable when the actual
quantity of food consumed was considered. The directions on the can of
this food, called for a certain amount of the barley powder to be mixed
with boiled water; and in an additional paragraph it was directed to mix
this with a certain amount of milk. When I requested the mother to state
how she prepared the food, I was astonished to learn that she had
evidently never read the second paragraph of the directions. She was
feeding her baby on barley powder and boiled water,--an excellent
starvation diet. When her attention was called to the grave carelessness
she had been guilty of, she was the most contrite mother I ever knew. As
soon as the milk was added to the food the baby immediately began to
thrive was very soon a robust, healthy infant.

Of course these were errors of bad judgment and gross negligence of
which few mothers would be guilty, but these types of mistakes come to
the attention of physicians frequently, and emphasize the need of
constant vigilance in every detail in the management of babies if we
wish to achieve success.


FEEDING DURING THE SECOND YEAR

At the beginning of the second year the child should be fed at the
following hours, 6 and 10 A. M., 2, 6, and 10 P. M.

Early in the second year the child should be taught to drink from a cup.

A proper diet for a child of twelve months, of average development,
would be as follows:

6 A. M. Milk and barley water, or milk and oat gruel, in the proportion
of seven ounces of milk to three ounces of the diluent.

9 A. M. The juice of an orange (strained).

10 A. M. The same as at 6 A. M.

2 P. M. Chicken broth with rice or stale bread crumbs, six ounces; or a
light boiled egg mixed with stale bread crumbs; or beef juice, three
ounces. Milk and gruel same as at 6 A. M., but four ounces only.

6 P. M. Two tablespoonfuls of cereal jelly in eight ounces of milk; a
piece of stale bread and butter. (The jelly is made by cooking the
cereal for three hours the day before it is wanted; it should then be
strained through a colander; oatmeal, barley, or wheat may be used.)

10 P. M. Same as at 6 A. M.

About the fifteenth month the cereals may be given much thicker and fed
with a spoon. The child can at this time take a number of various fruit
juices. Orange juice is the best. Carefully strained juice of ripe
peaches, strawberries, raspberries, may be given in reasonable amounts,
one or two tablespoonfuls, once daily. Custard, cornstarch, plain rice
pudding, junket, wheatena, cornmeal, hominy, oatmeal, zwieback, bran
biscuit, each with butter, may be added in reasonable quantities between
the eighteenth and twenty-fourth months. When cereals are given they
should be thoroughly cooked, usually for three hours, and strained. When
apple sauce is given to a child about the second year it should contain
very little sugar and baked apples should be fed without cream. Water
must be given to the child between meals especially during the summer.
It should be boiled and cooled kept in a cool place. The following
schedule for a child about the third year constitutes a good average
diet for a healthy child:


TABLE OF STANDARDS

(As Adopted and Copyrighted by the American Medical Society)

PHYSICAL DEVELOPMENT

[Transcriber's Note: The ages were difficult to read and may not all be
correct.]

Age in Months
   Weight
          Height
                  Circumference of head
                            Circumference of chest
                                    Circumference of abdomen
                                            Lat. Diameter of chest
                                                   Chest front to back
                                                          Length of arm
                                                                  Length of leg
-------------------------------------------------------------------------------
   lbs.   in.      in.      in.     in.     in.    in.    in.     in.
 6   17    27      17-1/2   17-1/2  17-1/2  5      4-1/2  10      10
 9   19    28      18       18      18      5      4-1/2  11      11
12   20    29      18-1/2   18-1/2  18-1/2  5      4-3/4  12      12-1/2
16   23    30      18-1/2   18-1/2  18-1/2  5-1/2  5      12-1/2  13-1/2
21   24    31      18-1/2   19-1/2  19-1/4  6      5      14      15
24   25    32      19       20      19-1/2  6      5      14-1/2  15-1/2
28   27    33-1/2  19       20      19-1/2  6      5      14-3/4  15-3/4
32   29    35      19-1/2   20-1/2  19-1/2  6-1/4  5-1/2  14-3/4  15-3/4
36   32    36-1/2  20       21      20      6-1/4  5-1/2  15      16-1/2
===============================================================================


MENTAL DEVELOPMENT

     Attention, facial expression, irritability and disposition
     should be considered.

     Six Months

     Child sits unsupported for a few minutes.... Balances head....
     Eye follows a bright object.... Looks in direction of an
     unexpected sound.... Child seizes an object and holds it....

     Twelve Months

     Stands and walks with support.... Makes a few sounds, such as
     mam-mam, da-da, co-oo.... Plays with toys.... Attempts to use
     paper and pencil.... Shows interest in pictures.... Clings to
     mother....

     Eighteen Months

     Child walks and runs alone.... Says a few words, such as Mama,
     Papa, Baby.... Points to common objects in pictures....
     Imitates a few simple movements, such as placing hands on head
     or clapping hands....

     Two Years

     Runs.... Repeats two or three words.... Knows features....
     Obeys simple commands, such as "Throw me the ball".... Imitates
     movements....

     Two and One-Half Years

     Talks in short sentences.... Knows names of members of the
     family.... Roughly copies a circle.... Recognizes self in
     mirror.... Imitates more complex movements....

     Three Years

     Talks distinctly.... Repeats sentences of six simple words....
     Repeats up to two numerals--meaning repeats first one numeral
     and then two numerals.... Enumerates objects in a complex
     picture and attempts to describe it....

     Four Years

     Knows its sex.... Names familiar objects, such as key, knife,
     etc..... Repeats three numerals.... Compares two sticks (can
     select the longer).... Distinguishes the longer of two
     lines....

     Five Years

     Compares weights and lengths.... Copies a square.... Counts
     four pennies.... Describes a picture....

Breakfast:--(7 to 8 o'clock) Oatmeal, hominy or cracked wheat (cooked
three hours), served with milk, a little salt but very little sugar. A
soft egg, boiled, poached, or coddled. Stale bread and butter. One glass
of warm milk. At 10 o'clock, the juice of one orange.

Dinner:--(12 o'clock) Strained soup, four ounces. Chop, roast beef,
steak, chicken, small quantity of any one. Baked potato and cooked rice,
or spaghetti. A selection of green vegetables may be made from asparagus
tips, string beans, peas, spinach, cauliflower, carrots; they should be
cooked until very soft, and mashed or put through a sieve. For dessert,
plain rice pudding or bread pudding, stewed prunes, baked or stewed
apple, junket, custard or cornstarch. A glass of milk or water.

Supper:--(6 o'clock) Cereal; farina, arrowroot, cream of wheat, wheatena
(each cooked two hours), with salt but no sugar. Give two or three
tablespoonfuls. Drink of milk with stale bread and butter. Twice a week,
a little plain ice cream, or junket, custard or cornstarch.

Three meals a day at this time are better than more frequent feedings.
The child has a better appetite and much better digestion. It may be
found necessary to give delicate children a luncheon at 3 o'clock. A
glass of milk and a Graham wafer, or a cup of broth and a zwieback, will
answer the purpose. Children recovering from serious illness will need
more frequent nourishment. Up to the sixth year the diet may conform to
the above schedule, increasing the individual quantities as
circumstances may warrant.


THE DIET OF OLDER CHILDREN (FROM SIX TO TEN YEARS)

After the sixth year the diet will conform to the adult diet, with
certain exceptions. The important exceptions are as follows: All meats
are to be excluded except roast beef, steak, lamb chops, roast lamb,
mutton chop; all meats should be cooked rare and either scraped or
finely divided. They should be broiled or roasted, never fried, and
never given oftener than once daily, and then only in small quantity.
Pies, rich puddings, pastries of all kinds, gravies, sauces, all highly
seasoned dishes; wine, beer, coffee, tea, should never be given to
children. Ham, bacon, sausage, pork, liver, kidney, game, and all dried
and salted meats, codfish, mackerel and halibut, are particularly bad.

The following articles are permissible: Broiled chicken, shad, bass. The
"platter gravy" from a roast is very nourishing if given in small
amounts. Milk should continue to form an important part of the dietary
up to the tenth year. It should be clean and fresh but not too rich.
Sometimes it is found advisable to dilute the milk with water that has
been boiled and cooled. Some children will take it if a pinch of salt or
bicarbonate of soda is put into it, and they will digest it easier and
better. They should never be allowed to take more than one quart daily
and frequently less will do more good. Cream is not good for children of
this age. Eggs are valuable; they should never be given fried or in the
form of omelets, they are best given boiled, poached or coddled and only
slightly cooked. It is never necessary to give more than one egg at a
meal. There are children with whom eggs do not agree; these children are
disposed to "biliousness."

VEGETABLES.--Certain vegetables are objectionable at this age: Raw
celery, radishes, raw onions, cucumbers, tomatoes, lettuce, corn, lima
beans, cabbage, egg plant. The following are good: White potatoes (never
fried), spinach, peas, asparagus tips, string beans, celery, young
beets, carrots, squash, turnips, boiled onions and cauliflower. It is
important to remember that all vegetables should be thoroughly cooked;
they cannot be cooked too much. After boiling for some time the water
should be drained off and fresh water used to complete cooking.
Vegetables should be fed in small quantities. From the third to the
tenth year they form an important and essential part of the diet of all
children. After the tenth year they can be eaten as served to adults,
and other vegetables may then be added. As a rule salads of all kinds
should be omitted until after the twelfth year.

CEREALS.--Children should not be allowed to eat too much cereal at one
meal,--never more than one small saucerful. Cereals should be properly
cooked. It is not safe to adhere strictly to the directions on the
package of any cereal. As a rule they require much longer cooking. They
are best cooked in a double boiler. They may be served with milk, salt,
and not more than one teaspoonful of sugar.

BREAD.--Fresh bread is never allowable. Graham wafers, oatmeal crackers,
Huntley and Palmer breakfast biscuits, bran muffins, rye bread, corn
bread, stale rolls, are all suitable to growing children.

Hot bread, fresh rolls, buckwheat or griddle cakes, all sweet cakes, are
objectionable.

DESSERTS.--The only permissible desserts for this age are junket,
custards, plain rice, or sago; or bread pudding. The only safe rule to
follow so far as "sweet things" are concerned, is not to give them at
all. This applies to candy, ice cream, pies, pastries, jam, syrups,
preserved fruits, nuts and dried fruits. The parent who indulges a child
to "a taste," is guilty of a bad habit, and it can only lead to trouble.

FRUITS.--These should always be fresh and selected with care. Fruit is
the most important article of diet to a child of this age. Up to five
years it is safest to use only cooked fruits and fresh fruit juices: of
these the juice from sweet oranges, grape fruit, peaches, strawberries,
and raspberries may be given. Stewed or baked apples, apple sauce, figs,
prunes, peaches, apricots, pears are excellent because of their effect
on the bowels. When the bowels are loose, and especially in hot weather,
great care must be taken when fruit of any kind is used. The pulp of any
fruit should never be used; cherries, bananas, pineapples, and berries
are not to be given to children. Milk should never be allowed at the
same meal when sour fruit is served.




WHAT MOTHERS SHOULD KNOW




CHAPTER XXI

     "Life has taught me that it is the women of a country in whose
     hands its destiny reposes. No cause that is not great enough to
     command their devotion and pure enough to deserve their
     sympathy can ever wholly triumph."

     JOSEPH H. CHOATE.

THE EDUCATION OF THE MOTHER

     What Mothers Should Know About the Care of Children During
     Illness--A Sick Child Should be in Bed--The Diet of the Sick
     Child--A Child is the Most Helpless Living Thing--The Delicate
     Child--How to Feed the Delicate Child--How to Bathe the
     Delicate Child--Airing the Delicate Child--Habits of the
     Delicate Child--Indiscriminate Feeding--Poor Appetite--Loss of
     Appetite--Treatment of Loss of Appetite--Overeating in
     Infancy--What Correct Eating Means--Bran as a Food--Breakfast
     for a Child at School--Lunch for a Child at School--Bran
     Muffins for School Children--Bran Muffins in
     Constipation--Hysterical Children--What a Mother Should Know
     About Cathartics and How to Give a Dose of Castor Oil--Castor
     Oil--Calomel--Citrate of Magnesium--When to Use Castor
     Oil--When to Use Calomel--Vaccination--Time for
     Vaccination--Methods of Vaccination.--Symptoms of Successful
     Vaccination.


WHAT MOTHERS SHOULD KNOW ABOUT THE CARE OF CHILDREN DURING ILLNESS

Every child has a certain amount of vitality and resistance. When
illness comes it should be our duty to maintain the vitality and
resistance to the highest degree. We should, therefore, irrespective of
the nature of the illness, surround the child with all the conditions
that will minister to the preservation of whatever strength and vitality
the child has. Experience has taught us that there are certain
requirements that should be carried out in the general management of
sick children.

A SICK CHILD SHOULD BE IN BED.--In the first place a sick child should
be in bed. There is no exception to this rule. It is impossible to do
justice to a child if you allow him to dissipate his strength and
exhaust himself moving from place to place while he is sick. A mother
should not forget that it is she who must exercise wisdom and decide
what is best for her child. The judgment of a sick person is not to be
relied upon, and it would be wrong to submit to the whims and fancies of
an ailing child, if these are known to be medically disadvantageous to
its best interests.

Quiet surroundings are essential in all acute illnesses. The nurse
should be congenial to the child. If the patient demands the presence of
the mother she should remain, but she should not try to entertain him or
interfere with the nurse.

The clothing of the patient should be the ordinary night-dress which is
worn in health. In no disease is any special kind, or quantity of
clothing required.

The temperature of the room should be 68° F. Thermometers are cheap and
an exact knowledge of the degree of heat in a sickroom is an essential
requisite. Nothing drains the vitality during sickness quicker than
varying degrees of heat and cold. It uses up nerve force and energy and
renders the patient irritable and difficult to manage.

The strictest attention should be paid to the ventilation of the
sickroom. We are learning more and more that fresh air is essential to
the speedy cure of all diseases and to the general well-being of the
patient. A direct, continuous communication between the sickroom and
out-of-doors is imperative. It is a splendid measure to use two rooms
for the patient and to change him twice daily, and to air thoroughly the
unused room.

The sickroom itself should be large and in a quiet part of the house. In
summer time the windows may be wide open, in winter months the degree of
ventilation can be regulated by the thermometer.

Many mothers fail to appreciate that drinking water is an important
requisite in all ailments of childhood, should be given freely, but it
should be known to be absolutely pure. The same rule applies to sponging
the patient. It must be done every day; sometimes it is necessary to do
it more often, but if so it will be so directed by the attending
physician.

THE DIET OF THE SICK CHILD.--Prescribing the diet of the sick child is
an important undertaking. It should be remembered that during sickness
the digestive capacity is reduced; consequently the food must be
lessened in quantity and in strength. If the patient is an infant at
breast the best way to accomplish our purpose is to give before each
feeding two ounces of boiled water, cooled to the temperature of the
body. This dilutes the mother's milk and renders it more easy of
digestion. If bottle-fed, it is accomplished by replacing one-half of
the milk with water. In certain diseases milk is totally withdrawn, but
these cases will be noted when discussing the treatment of the various
diseases. With older children, we give milk diluted with water, or
gruels, soups, or cereals, as conditions warrant.

Needless interference with the patient must not be indulged in. Sleep
and quiet are essential features of nature's reparative process. It is
seldom necessary to disturb a sick child for the giving of food or
medicine oftener than every second or third hour. Medicine may always be
given with food. Meddlesome interference, talkative attendants, or
excessive noise may exhaust a child and may prolong and render dangerous
or fatal a condition that would otherwise go on to recovery.

One satisfactory movement of the bowel daily is essential to the comfort
and progress of a sick person. If this does not take place naturally, it
should be obtained by an enema.

At the beginning of any illness in childhood it is a safe procedure to
give a dose of a suitable cathartic as soon as it is discovered that the
child is sick.

A CHILD IS THE MOST HELPLESS LIVING THING.--Nature endows the young of
every species--except those of the human family--with certain instincts,
which, when developed, govern and control their lives absolutely. The
technical definition of an instinct is an exceedingly complicated word
picture. It is only essential to an intelligent understanding of our
subject that the reader should have a definite idea of the difference
between an act that is the result of a process of reasoning and an act
that is the result of an instinct. If a man finds his way out of his
burning home he will stay out as long as there is any danger. The
crudest kind of reasoning will teach this lesson. A horse, on the other
hand--and incidentally it may be noted that a horse is regarded as an
intelligent animal--if led out of a burning stable and let loose, will
immediately reënter and be burned to death. The horse is the victim of
instinct; he obeys the unconquerable instinct to return to his stall--he
cannot reason as the man can that a home that is burning is not a proper
place to seek safety in. When an ostrich fears danger he buries his head
in the sand, under the impression that if his head is out of sight he is
safe from danger. This is his instinctive plan of procedure in the
presence of danger, and it is the plan of every ostrich, everywhere,
always. A little reasoning would show them how foolish the idea is--but
they cannot reason. That is the province of man alone. If the first
member of a flock of sheep jumps over a fence to get into the next
field, every member of the flock will follow, each one jumping the
fence, though there may be an open gate between the two fields a few
yards away. Instinct dictates the plan to the sheep as they have
received instructions from their ancestors always to "follow the lead."
This is their hereditary legacy and they cannot disobey it.

Animals are born with instincts which need only circumstances to bring
them out. Now a baby is not born with instincts of this character,--it
has not even the instinct to help itself; it cannot find the breasts
that were made for it; it is more helpless than the baby cat or dog or
worm. Therefore a baby in whose brain the potential faculty of reason is
slumbering must of necessity begin its career wholly dependent upon the
supervision and love of its mother, until such time as it may be capable
of reasoning for itself. Motherhood is therefore the supreme privilege
of womanhood. It cannot be superseded, hence the fundamental factor in
any system of race culture, or in any system of infant mortality, must
tend to raise the quality and the intelligence of motherhood as a basic
necessity. Motherhood at the present time, though the most important and
sacred profession in the world, is almost exclusively carried on by
unskilled labor. The maternal instinct is deeply rooted and universal;
its absence must be regarded as an abnormality, or as a product of
misdirected education. The requisites for the mothers of the future
should be absolute physical health and love of children.

If nature endowed a baby with instincts there would be no need for
reason or education. Education cannot teach a cat how to nurse or wash a
kitten any better than it does,--its instinct is good enough. The mother
of a human baby, however, is not born with the instinct which enables
her to care for her baby equally as well as the cat cares for her
kitten. She must be educated or taught to care for it. She can then care
for it better than the cat cares for the kitten, and she can be taught
to bake, to sew, to read; to play on the piano, which a cat cannot be
taught. So while a baby may be the most helpless living thing at one
stage of its career it has in it--in the faculty of reasoning--the
ability to become the Lord of all the Earth and of all the animals
therein. To limit the environment of a child by imposing instincts upon
it, would be to limit its inherent freedom. To be obliged to obey a
prescribed instinctive law would rob mankind of his creative or
reasoning faculty, and that would be to lower him to the level of the
brute creation. Reason is of no use if our acts are already determined
for us. There are therefore good reasons why the human baby should be,
at the moment of its birth, the most helpless living thing; and as a
consequence it is imperative, if the eugenic ideal is worthy of
attainment, that every baby should have the benefit of trained and
efficient care and education.


THE DELICATE CHILD

There is a certain standard by which we measure the physical and mental
development of children. This standard we regard as the evidence of
normal development. Some children exceed these requirements; they are
bigger and stronger at a given age than the average child at the same
age. There are other children who cannot be called sick, but who are
physically and mentally inferior to the average standard, whom we
designate as "delicate." These children are not as big, or as strong, or
as heavy, as other children of the same age. They are born with a
reduced vitality, or through mismanagement in early infancy they have
acquired a subnormal standard of development. Children born of parents
who are not of standard vitality are predisposed to be delicate. If the
parents are of average development, and the delicacy of the child is
acquired by mismanagement, the proper dietetic and hygienic management
will, as a rule, promptly result in a satisfactory restoration to normal
health.

TREATMENT.--When a mother awakes to the knowledge that her child is
delicate; when she understands that her child's vitality is not what it
should be, and when she resolves to "do something" in the interest of
her child, she is on the right road, and we hope to encourage her in the
good intention. We would however tell her that her effort must be
thorough, and that she must be patient and persevering. If she does not
falter in well doing she will succeed beyond her expectation, and the
satisfaction she will experience in noting the evidences of returning
health and strength in the appearance and conduct of her child, should
be ample recompense for the effort made and the time bestowed.

She must begin with a definite knowledge of just what she intends doing;
she must know, however, what must be done and she must begin at the
beginning and build from a sure foundation. It is therefore absolutely
essential to ascertain if there is any actual disease underlying the
reduced vitality which is responsible for the delicacy of the child;
this necessitates a thorough examination by a competent physician. If
you are assured there is no disease present, no tuberculosis, no
syphilis, no malaria, and that debilitating conditions, such as
adenoids, sexual abnormalities, the results of self-abuse, skin disease,
do not exist, then certain fixed rules can be laid down, and definite
principles followed in the daily management.

WEIGHT, AS A STANDARD OF DEVELOPMENT.--It has been stated elsewhere in
this book that one of the safest guides to follow, as to whether a child
is thriving, is its weight. This can be relied upon as a general rule. A
child should therefore be weighed regularly every week. If it is not
gaining an average of four ounces weekly it is not thriving up to
standard. When the average is below four ounces there is something wrong
with the quality or quantity of the food.

HOW TO FEED THE DELICATE CHILD.--If the child is breast-fed and the
weight standard, as evidenced by the weekly averages, is persistently
below normal, we must find a substitute for the mother's milk. If the
child is bottle-fed and it is demonstrated that it is impossible to
maintain normal development on cow's milk, a wet-nurse should be
obtained. After the child is weaned, or put upon a more liberal diet,
milk should continue to be the chief article of diet. From the first to
the third year a child should take one quart of milk daily in addition
to the other food. There are some children, however, who seemingly
cannot take milk without getting indigestion; they should be put on
skimmed milk, to which may be added a small quantity of sugar to make up
for the loss of fat. Mothers must be certain that too much milk is not
given, or the desire for other necessary food will diminish.

After the first year it is a very good plan to give one teaspoonful of
scraped beef daily. If this is well borne, two may be given and later
three. It can be given immediately before the regular feeding of cereal
and milk. From the twelfth to the sixteenth month eggs may be given: at
first one-half, and later a whole egg mixed with bread crumbs. Various
vegetables should also be given cooked in the form of a purée. If at any
time the child should refuse the food, or act as if it had no appetite,
leave the milk out of the diet; this may then restore the appetite and
it will take the other food freely; the milk can be resumed later.

As the child grows older, the distaste for milk may grow, or he may be
one of those children with whom milk really does not agree; in either
event, do not hesitate to leave it out of the child's dietary. These
children should be encouraged to eat plenty of good butter on their
bread and crackers. Butter will not only agree with them, but it will
supply any fat deficiency in the general diet. The diet may now consist
of milk (unless it disagrees), cereals cooked three hours, raw or rare
meat, poultry, eggs, vegetables, purées, cooked and raw fruit, bread,
crackers.

HOW TO BATHE THE DELICATE CHILD.--Regular daily baths are particularly
of benefit to the delicate child, despite the prevailing fear that they
may catch cold. The salt bath is advised and the time to take it is just
before retiring. The room should be warm and the temperature of the
water should be 90° F.: it should not last longer than five minutes, and
the water should be cooled down to 70° F., before the child is removed
from the bath. While the cold water is running in, the surface of the
body should be briskly rubbed with the mother's hands and after removal
the child should be dried with a fairly coarse bath towel to ensure a
good reaction. Very delicate children need not have the temperature of
the water reduced; others may stand water of 80° F., but no lower. In
the poorly nourished it is frequently advantageous to rub the body,
after drying, with olive oil or goose oil. This aids nutrition and
because of the massage it aids circulation. In some older children a
daily cold spinal douche seems to act particularly well. If the child
does not promptly react from the effect of the cold water it is best to
discontinue it.

AIRING THE DELICATE CHILD.--Delicate children should, above all things,
be assured of the maximum amount of fresh air and sunlight. Many mothers
entertain the idea that these children are disposed to take cold easily,
if in the open air,--which is not the case. All children need an
abundance of fresh air and the delicate need it particularly. The season
of the year and the character of the weather will, of course, dictate
just how much open-air exercise they may take.

If the weather is very cold and the air damp, or if there is a very cold
high wind, it is best to remain indoors; otherwise the child should
remain out for four or five hours. Indoor airing is obtained by
dressing the child to go out-doors, putting him in his carriage, and
leaving him before an open window in a room of good size with all the
doors closed so as not to create a draught.

HABITS OF THE DELICATE CHILD.--The amount of sleep necessary for a
delicate child is the same as for a normal child of the same age. The
room should always be well aired, night and day, and should be devoted
to the exclusive use of the child.

These children should never be allowed to sit on the floor. It is always
a difficult matter to avoid this, but it must be religiously guarded
against; otherwise a cold is the inevitable result.

A change of air is sometimes advisable and essential, especially during
the hot, humid weather of July and August. Much better results will be
obtained by sending these children to the mountains than to the
seashore.

Delicate children should always be clothed warmly, but not too warmly.
The feet and legs must always be kept comfortable. Moderate exercise,
short of fatigue, is necessary. A midday nap after the noon meal should
be taken every day. The child should be undressed and put to bed for two
hours and left there, whether it sleeps or not. This applies to delicate
children of all ages.

The education of delicate children should be postponed until the health
is restored. They should, however, be made to obey and they should be
taught good habits. When school work begins it should be made light and
easy. They should not go to school before the eighth year, and then not
unless physically fit. They should not play at rough games or with rough
companions, though it is not wise to shield them too much. Their habits
and peculiarities should be studied and every possible effort made to
direct them kindly and wisely so that they may contribute to their own
upbuilding.

A systematic observance of these suggestions will save many lives and
will aid very considerably in producing stronger men and women. Infinite
patience, tact and self-sacrifice is necessary, but the results in every
case justify the measures adopted.

INDISCRIMINATE FEEDING: POOR APPETITE.--In considering many of the
diseases of childhood the term "indiscriminate feeding" is used. An
explanation of just what is meant by this will be of decided advantage.
There are two fundamental essentials in the successful feeding of
infants and children: regularity and suitable food.

A child whose feeding intervals are not regular and whose food is
unsuitable is a victim of indiscriminate feeding.

The lack of observance of the regularity rule always leads to loss of
appetite and indigestion.

Loss of appetite is a serious condition in a growing child and may give
infinite trouble. Indigestion in a growing child is unnecessary,
unfortunate, and frequently is the one factor that spoils an entire
life. It is unnecessary, because it means and is caused by neglect on
the part of the mother; it is unfortunate, because it always paves the
way for any serious ailment that is epidemic or "in the air"; and it is
important, because it very frequently weakens the stomach and renders it
unfit for normal digestion for a long period, if not for life.

If for some reason a child's appetite becomes poor and it is not
properly managed until the appetite is restored to normal,
indiscriminate feeding is always the result.

The reason for the poor appetite may be because the child is kept
indoors too long, or because it is being fed on unsuitable food, or is
living in unsanitary surroundings, or many other reasons, sometimes
trifling reasons, may cause it. When a child will not eat at meal time,
the mother feels that it should eat sometime, so she encourages it to
eat between meals, and because of a mistaken kindness she breaks the law
of regularity,--a law that can never be broken without serious results
following. A child in this condition becomes a disturber of the peace;
the parents can do nothing with him; he insists on eating just what he
likes and when he likes; and he chooses, as a rule, candy, cake,
pastries, ice cream, tea, coffee. Indigestion follows, the child loses
weight, is languid and listless and constipated.

When finally the physician is called in he finds it necessary to go back
to first principles. He lays down the law in a definite, stern way, and
the mother and the child must obey. Most parents know and admit they are
doing wrong to give in to a whimsical child, and if they would only make
up their minds to conquer when conquering is easy they would save
themselves many heartaches, many regrets, and the child much suffering
and much possible permanent injury as a consequence. Usually one parent
is willing to be master but the other lacks the mental equipment to meet
the issue, and argues, as he or she imagines, in favor of the child. The
parent whose instinct is correct, whose judgment is true, whose
interpretation of the situation is just, should not be dissuaded, or
argued away from his or her duty. If it is the first real problem in
your domestic experience in which a decided stand must be made, make it
without fear and without hesitation, and carry it through to the bitter
end. Results will justify and vindicate you.

The general treatment of these children will be found outlined in the
following paragraph on Loss of Appetite.

LOSS OF APPETITE.--If a child complains of not being hungry, and will
not take enough food, and if this condition continues for some time, we
must regard the matter as being abnormal and find the cause. This is
necessary because a child must eat in order to maintain a certain
standard of growth and vitality. These children are not sick; they are
active and continue to play as usual and they sleep soundly, but they
have no appetite. One of the most frequent causes of this condition is
too frequent feedings. Some children are naturally small eaters. They
thrive and maintain a satisfactory weight; their system seems not to
demand large quantities or even ordinary quantities of food. Parents
observe this habit of little eating and begin to coax and bribe the
child to eat more at meal time, and to eat between meals. In this way
the child really overeats, the appetite becomes capricious, and the
stomach rebels. In a very short time the condition of "loss of appetite"
is established as a consequence. Another cause is the drinking of too
much milk, and yet another and very common cause is indiscriminate
eating of candy, cakes crackers, and fruit between meals. Children who
are fed at the table with adults eat things they should not eat, and
spoil their digestive organs and loss of appetite is the result. The
Scotch custom of compelling children to eat at a separate table is an
excellent one. They are not tempted to ask for things they cannot have.
Lack of fresh air and exercise frequently results in impaired appetite.

TREATMENT.--The very first thing to do with these children is to stop
any habit that may be responsible for the loss of appetite. If the child
has been eating between meals, stop it absolutely. If too much milk has
been taken, stop milk entirely. If the child has not been getting enough
fresh air, or if it has been sleeping in a badly ventilated room, or if
baths have been too infrequent, rectify the fault. If eating at the
family table and fed indiscriminately, change the programme; feed him
before the family sits down to meals. Now regulate the time of feeding
to suit the age of the child and adhere to strict regularity. It is a
pernicious and absolutely wrong custom to force children to eat, or to
coax them to eat when they do not want to eat. Loss of appetite will
never be cured by forced feeding, or by reducing the interval between
feedings, or by giving the child stronger or more concentrated food
under the mistaken idea that in this way the loss of appetite can be
"made up." The interval of feeding should rather be lengthened than
otherwise in order to give the digestive organs an opportunity to regain
the normal desire for food. Pay strict attention to the bowels. Be
certain the child has a daily satisfactory movement and that he drinks
frequently between meals.

If the child does not promptly respond to the proper hygienic and
dietary treatment as outlined above there are two things that can be
done:

1st: Send the child away. A change of scene and climate will sometimes
work like a charm in these cases, and will, after a reasonable length of
time, establish a permanently good appetite.

2nd: If this is not possible, as sometimes it may not be with poor
patients, then we can give the child suitable tonics.

OVEREATING.--The large majority of individuals eat too much. Most of us
would enjoy better health, better spirits, and greater efficiency if we
consumed from one-third to one-half less food than we habitually do.

Every living organism requires a certain amount of nourishment according
to the work performed and to replenish wear and tear; when food is
supplied in excess, the system cannot utilize it, but it is compelled to
rid itself of the excess in some way. The work involved in this
eliminating process is exceedingly detrimental to the various organs and
to the individual. To overeat is to overwork, and to overwork a machine
or an animal is not only poor economy but bad judgment. If the digestive
apparatus is required to work overtime, it is a self-evident assumption
that the various organs will not digest efficiently the food necessary
for ordinary existence. If the necessary nourishment is not adequately
digested, the general health will suffer as a consequence. If the
general health is below standard the individual will not be competent to
carry on the requirements of a normal, healthy life.

We must, however, give some thought to the effect which the excess of
food exerts upon the human machine.

Nature provides and maintains a standard relationship between the
capacity of the individual and his needs. A child has a digestive
capacity to digest and assimilate a quantity of food sufficient for his
growth and proper nourishment; an adult maintains the same standard
according to his requirements. All the other organs are adjusted to
harmonize with this scheme. If we overeat, the immediate result is to
disorganize this relationship between the various organs; hence we have
a multitude of effects which manifest themselves in various ways as a
direct result of overeating. The combined general effect expresses
itself in the form of what is regarded as poor health and a low standard
of efficiency. When a larger quantity of food is taken into the stomach
than it can properly digest within a reasonable time, two conditions
immediately follow. The stomach itself is dilated and the food is not
thoroughly digested. If the habit is persisted in, indigestion, and
later chronic gastritis ensues. The direct symptoms of these conditions
are given in detail in another part of this book. Very few individuals,
however, appreciate the indirect consequences of overeating and of
indiscriminate eating on the general health. It is impossible to
tabulate in so many words the effect which this habit has on efficiency
and temperament. We read and hear a great deal to-day about efficiency.
Now, an individual's efficiency is an expression of that individual's
health standard or capacity. To be 100 per cent. efficient one must
enjoy good health. It would be absurd to expect a high standard of
efficiency from an individual with a low standard of health. Poor health
means poor vitality. Vitality is the mark of the master. Without
vitality one can never dominate. All the great achievements of the race
have been consummated by those who conserved their vitality. No single
factor contributes a larger percentage of inefficients and failures than
overeating. The man or woman who, from habit or experience, has learned
the lesson of right eating and living need not be lacking in efficiency,
nor need they despair of the attainment of success.

SYMPTOMS OF OVEREATING.--Efficiency depends not only upon one's capacity
to perform, but upon the character of the performance. The spirit must
be willing to perform. The overeater is heavy, phlegmatic, indifferent,
lacking in energy, tact and initiative. She is constantly subjecting her
system to needless overwork; she is depressed, nervous, imaginative and
she is not ambitious. She is a victim of self-poisoning, of
constipation, indigestion, headaches, flatulency, neuralgia, vertigo,
and melancholia. An overeater never enjoys good health, never is
efficient, and cannot possibly be successful.

To enjoy good health one should know how to select food and how to
combine and proportion it. It has been said that the American people are
a race of dyspeptics, and it must be admitted that the assertion is
more or less true. There are millions of people who suffer from
indigestion in some degree, and it may justly be said that indigestion
has its beginning in overeating, in some form. It may not be overeating
in actual bulk, but it is overeating some article or articles that do
not agree with the individual, and the fact that certain articles do not
agree is unquestionably dependent upon the nervous temperament of the
American people--and the temperament of a people is a product of the
kind of existence the people subject themselves to. We are, therefore,
unwittingly, victims of our environment.

Correct eating means simple eating--only a few things at a time. Food
should be selected according to one's age and occupation, and according
to the season of the year. To eat habitually large quantities and at the
same time a large variety is suicide pure and simple. If one dared to
make the experiment of cutting down one's diet one-half, it is
absolutely certain the effect would be immediate benefit. The benefit
would not only be manifest in the physical betterment, but the
efficiency and general well-being would be greatly enhanced. It is not
the kind of food that makes a dyspeptic, but the quantity. A well person
need not consider whether a certain kind of food will or will not agree,
providing she does not eat too freely of that food, or combine it with
other food. The combination of which may in itself form too much of one
kind at a time.

Some people imagine, for example, that oatmeal porridge does not agree
with them. When the matter is inquired into, however, it is found that
they habitually eat bread, eggs, and other articles, with coffee at the
the same meal with the porridge. From this combination they experience
distress and blame the porridge. If these would take a plate of oatmeal
porridge with cream and salt, and some stewed fruit for breakfast they
would not experience any trouble, and this would be an ample meal for
the ordinary individual. It is not the porridge, but the unsuitable
combination, that is at fault. The same may be said of milk. Many people
state that they cannot take milk and they deprive themselves of one of
the very best articles of diet because of this idea. There are very few
people in the world who cannot take milk in some way. It is not the milk
that is at fault; it is the combination of it with other less nutritious
articles that is the cause of the distress. Even candy is responsible
for thousands of cases of indigestion. Anyone may safely take a
reasonable quantity of good candy, but if it is taken at a wrong time,
or combined with other articles, it may readily produce indigestion.

Indiscriminate eating and overeating are prolific causes of rheumatism,
kidney disease, heart disease, liver troubles, obesity,
arteriosclerosis, and apoplexy. These diseases are notoriously on the
increase and must be construed as a direct consequence of the tendency
of the American people to overeat and to eat indiscriminately.

BRAN AS A FOOD.--In the chapter on constipation there may be found a
formula for making bran muffins. These muffins are invaluable to
children in health, and to the victim of indigestion or constipation,
whether child or adult. One muffin with each meal will solve the problem
of constipation in growing children without the use of drugs or other
aid. They will regulate the bowels of adults in many instances without
resorting to drugs.

Raw fruit in season, or stewed fruit, or a baked apple, with a light
boiled egg and one bran muffin, is an ample and a nourishing breakfast
for a child at school.

For lunch the same child should have a plate of thoroughly done
vegetable soup, a bran muffin, and more fruit. After school, a glass of
milk with two or three Graham wafers may be given.

For dinner the child at school may have a mixed meal. This meal should
not be later than six-thirty o'clock and the child should retire at
eight-thirty at the latest. A bran muffin should be taken with this meal
unless the child's bowels are too loose.

Mothers should insist on their children eating these muffins. If a child
eats only what it likes it will not eat what is good for it. If the
mother insists in the right way she will win; if she does not the child
will win. If the child wins, the mother is the wrong kind of mother. I
do not know of any other single article of diet that is of such value
to growing children as these bran muffins. Children who eat them
regularly will have less sickness than other children; they will be
strong, healthy and full of energy. The bran in itself is not
responsible for this list of excellent acquirements, but the regular
eating of the bran is. Most ailments of children are of
gastro-intestinal origin; bran keeps the entire length of the
gastro-intestinal tract sweet and clean; if the child eats a bran muffin
with each meal it will not have much desire or much room for any other
form of bread or pastry. If white bread or pastry is abstained from the
child will not have indigestion, or constipation, and hence it will not
be constantly poisoning itself as most children do whose diet is not
restricted and whose bowels are more or less constipated.

These muffins should be made of the ordinary unsifted bran. If this is
not procurable the sifted bran (Johnstone's) may be employed. This bran
may be bought in any good grocery.

Modern milling methods, modern cookery, and modern methods of forced
farming, have each contributed their share of rendering food inert and
frequently deleterious. The miller has extracted the coarse cellulose
from the various flours in the effort to manufacture a product suitable
to the super-civilized public demand. This cellulose is absolutely
essential to gastric and intestinal digestion, and if children are
deprived of it constipation and indigestion are the natural result.
Forced farming accomplishes the same effect--the fiber of the vegetable
is deficient. Bran is rich in mineral salts, iron, protein, and
phosphates, and gives to growing children the ingredients which ordinary
food is deficient in. Bran prevents intestinal fermentation and children
who eat it are free from intestinal gas and putrefaction. It harmonizes
chemically with all other foods. Children should be made to take it
every day as a matter of self-preservation and of duty.

HYSTERICAL CHILDREN.--Hysteria is not a disease of infancy or of young
children. It is seen as a rule after the eight year. Male as well as
female children may be the victims to an equal degree. It is much more
frequently seen in the offspring of parents who are themselves nervous,
or alcoholic, or who suffer from insanity, or have insanity in the
family history. If these children in addition to the hereditary
influence suffer from stomach or intestinal disease, or general poor
health and are overworked at school, they are very apt to become
hysterical.

They are capricious, indifferent, and excitable. Their disposition is
irritable; they frequently exhibit fits of great excitability of temper
and passion. They cry or weep without cause. They often have
hallucinations and while asleep have attacks resembling night terrors.
They complain of pains in the joints, and are frequently treated for
disease that does not exist. Such condition as hysterical cough, spasm
of the muscles of the face, mouth, eyes, and of the neck exist and are
difficult to diagnose from real disease. These children complain of
painful sensations and sensitive areas and exaggerate all symptoms
unnecessarily.

The possibility of curing these patients is good, providing the
treatment is faithfully carried out. It is less favorable when marked
hereditary influences are strong.

TREATMENT.--In all children of distinctly nervous type and especially
those of nervous parents, the first essential duty is to develop their
muscular system. Try in every way to make healthy animals of them.
Attention and treatment should not be directed toward the nervous
system. If the child is made strong by out-door life, good plain,
digestible food, early hours, regular sleep in thoroughly aired rooms,
regular bathing, and if the school work is conducted with moderation and
judgment, the nerves and the nervous temperament will participate in the
healthy growth which will follow as a result. Tea and coffee should be
forbidden. Exciting books and questionable entertainment as given in
picture shows and theaters must not be allowed. If older members of the
family, or parents, are excitable and nervous the children should be
sent away to the country from them.

They should be put in charge of a person who will exercise firm control
over them. It may be necessary to take these patients away from other
children, and isolate them under proper control until they are able to
control themselves. They should be interested in exercise that compels
them to work; they should live and if convenient sleep out of doors; and
they should take iron or cod liver oil, or any other indicated tonic. If
they complain of pain they should receive cold-water douches, or the
cold pack, or the shower bath; and they should be put to bed and treated
firmly but kindly. Attention to the bowels is always essential, because
these children are as a rule the victims of chronic constipation.

WHAT A MOTHER SHOULD KNOW ABOUT CATHARTICS AND HOW TO GIVE A CHILD A
DOSE OF CASTOR OIL.--Broadly speaking there are three kinds of
cathartics. I will, in a simple way, explain their action so that a
mother may know which one to select under certain circumstances.
Frequently a mother is told by her physician to "keep the bowels of her
child open." Few mothers know how to keep the bowels open, and as this
is an important matter, every mother should know the reason why "any"
laxative or cathartic is not always suitable.

CASTOR OIL.--This is one of the oldest and one of the best cathartics we
possess for children. It is a mechanical cathartic; it acts in exactly
the same way as a street-cleaning machine. It cleans the street by
sweeping or pushing everything before it.

CALOMEL--This is a chemical cathartic. It acts through the blood. When
it is absorbed by the blood its chemical ingredients act on certain
nerves as irritants. These nerves excite the liver and bowel to action
and an evacuation is the result.

CITRATE OF MAGNESIA.--This is a saline laxative. It acts by drawing out
of the bowel wall enough liquid from the blood to sweep the contents
out. It may be likened to the street cleaner who flushes and cleans the
street by means of a hose pipe attached to the water hydrant.

Under what condition should a mother use these remedies? Castor oil is
ordinarily the best cathartic in childhood; it is not, however, always
the best. Most ailments of children are of gastro-intestinal
origin--they have either overeaten or they have eaten the wrong kind of
food. The stomach and bowel are overloaded: they must be cleaned out. We
want a mechanical cathartic, one that will push everything ahead of it,
so we use castor oil. When a child needs a cleaning out, use castor oil.
By a "cleaning out" we mean, when we know he has eaten too much of a
questionable variety of food, as pastries, cakes, fruit, ice cream,
etc., as children do at parties; or when he has eaten unripe fruit, as
green apples, etc.; or when for some reason he is constipated and
complains of not feeling well, use castor oil.

If you decide to use castor oil, use enough. A large dose will act
promptly and with less pain and with more certain results than a small
dose.

It is always safe and it is always best to decide upon castor oil as the
proper remedy, if the child has no fever. If he has a fever he will most
likely vomit castor oil when another kind of cathartic would stay on the
stomach.

Castor oil works more effectively, more thoroughly, and is less likely
to be vomited if given on an empty stomach, so we give it two hours
after eating and we give no food for two hours after it is taken.

Castor oil is distinctly of advantage in many chronic diseases of the
intestines because of its healing properties. In chronic colitis, for
example, when the child is suffering with malnutrition, irregular bowel
action with an odor, and mucous or bloody stools, a combination of
castor oil and salol, in emulsion, in small doses,--to which a small
quantity of opium may be added or withheld according to the frequency of
the movements,--with an occasional colon irrigation, is sometimes
invaluable.

Mothers must remember that castor oil is not good in the treatment of
constipation, because its after effect is to constipate, consequently we
would not use it "to keep the bowels open,"--it is only of use to clean
the bowel out thoroughly when that is indicated.

HOW TO GIVE A DOSE OF CASTOR OIL--The best way to give a child castor
oil is as follows: Place the bottle containing the oil on its side on a
piece of ice in the ice box; chill it thoroughly. Take a tablespoon and
smear it with butter; pour the ice cold oil into the spoon; it will
stick together like a piece of chewing gum and it will slide out of the
buttered spoon in one lump. In this way it will not spread over the
mouth and teeth and throat, leaving a bad taste, but will go straight
and surely into the stomach. The child cannot swallow some and retain
enough in the mouth to sputter it all over itself and only get half a
dose; it will not nauseate it, because it practically is tasteless if
given cold, and the stomach will tolerate the cold oil much better than
when given in the ordinary way.

A baby can be given oil in the same way, but in smaller doses. When the
teaspoon is put into the mouth of a baby it should be immediately turned
on its side so that it will keep the mouth open. If the nose is held
closed and the mouth wide open for a few seconds the baby cannot spit
the oil out--it must swallow, and if the oil sticks together as cold oil
will, it gets the whole dose. It usually takes two persons to give a
baby a dose of oil--one to open the mouth and give the medicine, the
other to hold the nose and arms.

CALOMEL.--The general indication for calomel is fever. When a child
develops a disease it immediately gets a temperature, and very
frequently the fever is quite high because the slightest ailment gives a
child fever. When fever begins, digestion practically stops, it is
therefore imperative to clean the whole gastro-intestinal canal;
otherwise the undigested material will putrefy and poison the entire
system and render the disease more serious than it need be.

Now we select in such conditions calomel for two reasons:

First, because the presence of fever indicates that infection of the
blood is taking place; this may come either from the intestinal canal
itself, or from the germs of the disease with which the child is
suffering. Since calomel acts chemically through the blood it is the
cathartic indicated.

Second, because a cathartic like castor oil does not act through the
blood and it would most likely be vomited by a fevered stomach.

Certain conditions indicate calomel; biliousness and jaundice, for
example, because it has a specific action on the liver and if the liver
is at fault calomel is the proper remedy.

Calomel is best given in small divided doses, 1-10 of a grain every half
hour, for ten doses. It is best given combined with soda; every drug
store carries tablets of calomel and soda for this reason.

Calomel should never be given in the treatment of constipation, nor
should it be used indiscriminately by mothers, as much harm may result.
It has its specific use as indicated above, but it should never be used
under any other circumstances.

CITRATE OF MAGNESIA.--This is a mild laxative. After the bowels have
been thoroughly opened with castor oil or calomel, small doses of
citrate of magnesia may be given for a few days, "to keep the bowels
open." There is no danger or harm in its use if used for this purpose.
It must not be used, however, in the treatment of constipation of
children for the simple reason that you cannot cure constipation by the
use of drugs of any kind. Laxatives of this type have become a national
curse. Adults, especially women, use them constantly. All these
advertised saline laxative waters work by weakening the blood--when a
dose is taken the chemicals in it draw through the bowel wall blood
serum, and produce, because of the excess of this watery fluid, large,
and frequently many, liquid movements.

If this practice is continued, as it often is every day, the quality of
the blood will suffer seriously, and many individuals are the victims of
neuralgic pains, headaches, nervousness, insomnia, anemia, and general
broken health as a direct consequence of this pernicious habit.

Mothers will try to remember, therefore, that drugs and saline waters
have no place in the treatment of constipation in children or
themselves. Constipation must be treated by diet, exercise regular
living and by the observance of hygienic and sanitary common-sense
rules.


VACCINATION

TIME FOR VACCINATION.--The best time to vaccinate a child is during the
first three months if he is healthy. The reason for selecting so early a
period is because the constitutional disturbances are much less at this
time than in later childhood. It should not be done during active
dentition. If the child is delicate if his nutrition is bad it should be
deferred until a later time. Children suffering from eczema or from any
skin disease or those syphilitic should not be vaccinated until it is
compulsory, or until exposed to small-pox.

METHODS OF VACCINATING.--It is customary in America to vaccinate at one
point rather than to make a number of inoculations as is the custom in
some other countries. The leg or the arm is the usual location selected.
In infants the sore can be protected better on the leg; in children of
the run-about age, the arm is the better location because it can be kept
at rest easier.

Before vaccinating the skin should be rendered surgically clean; this
can be done by washing with soap and water, drying and then rubbing with
alcohol. The wound should be left uncovered for about twenty minutes to
dry, it may then be covered with a bandage, or with a vaccine shield.
The part should not be washed for twenty-four hours.

THE SYMPTOMS OF SUCCESSFUL VACCINATION.--Nothing is noticed until the
third or fourth day, when a red papule appears. In the course of the
following day a vesicle appears; this vesicle enlarges until it reaches
its full development on the ninth day. The size of the vesicle is about
one-half inch in diameter; it is surrounded with a reddish inflammatory
area for about two inches. The vesicle begins to dry and is shortly a
dark crust which remains from one to three weeks and then falls off. It
leaves a bluish scar which soon turns white and the part is roughened
and honeycombed. During the period when the vaccination is at its height
the child suffers from fever and irritability and loss of appetite.

If vaccination does not "take" in an infant it should be done two or
three times and if then unsuccessful it should be repeated every year
until it takes. The fact that vaccination does not take does not imply
that the child would not take small-pox but rather that the vaccine used
is not suitable. There are some children, however, who seem to be immune
to vaccination.

Sometimes the symptoms are more severe than those enumerated; this seems
to depend upon the susceptibility of the child. The vesicle may be much
larger and the area of inflammation much more dense and angry. The fever
may be higher and may last longer; there may be a general rash and the
degree of depression more profound. Vesicles may be produced on other
parts of the body as a result of scratching. Mothers must always
remember that vaccination is a surgical wound to begin with and that it
is capable of infection in the same way as are other wounds, and that
any result coming from such an infection is not due to the vaccine or to
the process of vaccination, but to the infection. Many people get unjust
ideas about vaccination from just such cases. If the mother is not
cleanly or neglects the vaccinated area and permits it to become
infected she must not and others should not decry vaccination as a
consequence. Anyone who doubts the virtue of vaccination is condemning
himself; he is simply ignorant of the accumulation of evidence in favor
of it and assumes a position without any possible justification. The
mortality of vaccination is stated by Voigt from statistics to be 35 in
2,275,000 cases. In fact, all the deaths are from causes which are
preventable and no doubt the result of direct carelessness on the part
of the operator or the mother.

TREATMENT.--The mother must understand in what way she may contribute to
the successful termination of a case of vaccination. She should see that
the part upon which the child is to be vaccinated is absolutely clean so
far as she can make it with soap and water. She should see that the part
is allowed to dry thoroughly after vaccination. She should not wash the
part for at least twenty-four hours. If a vaccine shield is put on she
should not disturb it. If the mother is prepared to do her part
faithfully a vaccine shield is not necessary from a medical standpoint
and in some cases it is objectionable. A simple, clean bandage is all
that is necessary. It is very important that the child be kept from
scratching the part; most of the troubles of vaccination come from this
habit. It is desirable that the limb should be kept at rest during the
stage when the process is at its height. If the vesicle discharges it is
necessary that the area should be kept clean and dusted with boracic
acid. If the wound becomes infected it must be treated by a physician.
The mother must not resort to home remedies in such cases unless she is
prepared to take the consequences, which may be serious.




CHAPTER XXII

CONSTIPATION IN INFANTS AND CHILDREN

     "It is a greater disgrace to be sick than to be in the
     penitentiary. When you are arrested it is because you have
     broken a man-made statute, but when you are ill, it is because
     you have disobeyed one of God's laws."

     Constipation--Regularity of Bowel Function--The Function of the
     Stomach--Fermentation--Incomplete Constipation--Importance of a
     Clean Bowel--A Daily Movement of the Bowel
     Necessary--Constipation in Breast-Fed Infants--Treatment of
     Constipation in Breast-Fed Infants--Constipation in Bottle-Fed
     Infants--Treatment of Constipation in Bottle-Fed
     Infants--Constipation in Children Over Two Years of Age--Diet
     List for Constipation in Children--Bran Muffins in
     Constipation--Treatment of Obstinate Constipation--Oil
     Injections in Constipation.


CONSTIPATION. REGULARITY OF BOWEL FUNCTION

The most frequent cause of ill health and inefficiency in the human race
is inattention to regulation of the bowel function. Good health depends
upon many causes of which good blood is an absolutely necessary
requisite. Good blood depends upon what feeds and sustains it. There are
other contributing factors, such as the proper kind of exercise, the
proper amount and quality of fresh air, the method of living, etc., but
these are all food in a sense. The food we take in is acted upon by the
various digestive juices until everything is extracted from it that
contributes to the building up of the body. Whatever is left, whatever
the body does not want, is immediately, or within a reasonable time,
passed out in the form of a movement of the bowels.

If any part of the digestive function is deficient, impaired health, or
mental and physical inefficiency expressed in the form of indigestion,
is the result. If the bowel is at fault, constipation is the usual
consequence. A perfectly healthy living machine must maintain a perfect
digestion and regular bowel movements.

THE FUNCTION OF THE STOMACH is to mix and churn the food, and to add
certain ingredients to the mixture so that before it is carried into the
intestines it is (as far as it is the stomach's duty to render it) ready
to be absorbed into the system. Before it reaches that part of the
intestine which absorbs, it is acted upon again and certain other
ingredients are added to it by certain other digestive organs. In time
it is in shape to be used and it is sent along on its way. As it passes
onward the little sucking glands in the wall of the bowel suck up all
the liquid element in the mass of food. The liquid element in the mass
is the food itself, rendered liquid by the stomach and other digestive
organs and juices. The remaining solid mass is that part of the food
which the body cannot use and does not want. By the time the liquid
element is absorbed, the solid mass (always kept moving by the bowel
wall) has reached the rectum, ready to be passed out at once, or very
soon, provided--and upon this provision depends the success of the
entire process,--it has all been done within a certain time. If the
stomach takes too long to do its work we have indigestion. If the bowel
takes too long to do its work we have constipation.

FERMENTATION.--Now let us consider the matter from another standpoint.
If food stays too long in the stomach it begins to ferment. When
anything ferments it makes and evolves gas. You, no doubt, have noticed
many times how the cork pops out of a bottle if its contents are
"working," or fermenting. If you watch that bottle you will notice that
it is quietly or actively evolving air bubbles. That is gas,--gas
manufactured by the process of fermentation. This is exactly the process
that goes on in the stomach or bowel of a dyspeptic, and it is this
collection of foul, poisonous gas that causes the distress and bloated
feeling which every dyspeptic suffers from after eating,--if it is this
"flatulent" type of indigestion which is present.

THE SIGNIFICANCE OF CONSTIPATION.--If the food takes too long to pass
through the bowel it causes, as we have stated, constipation. What is
the real significance of constipation? It means that in passing through
the bowel the food has given up all its liquid element (which is all its
nourishing element), but the bowel has been too slow in passing it
along. Consequently it is not ready to be expelled while it is yet a
harmless semi-solid mass. It stays in the bowel too long--it begins to
putrefy, bacteria attack it, and it is soon a semi-liquid, foul, rotting
mass. The sucking glands in the intestinal wall continue to suck--that
is their duty. They cannot discriminate between what is good and what is
bad--they simply go on absorbing whatever is there to absorb. So there
are absorbed into the system liquid and gaseous products which are
poison.

This process has been called by a number of names; "self-poisoning"
explains the condition thoroughly. The other names are, auto-infection,
auto-intoxication, enteric-infection, enteric-toxemia, intestinal
indigestion.

The condition is a serious one, because it is absolutely impossible to
feel well, or to enjoy good health, while it lasts. The feeling of being
constantly sick, yet not sick enough to stop working or to demand a
radical cure, affects a woman's efficiency, interferes with her capacity
to work, her ability to render the home an abode of contentment, to be
an agreeable companion, or to adequately take care of her children.

The constant absorption of intestinal poisons affects the system
itself,--the symptoms are headache, neuralgia, loss of appetite,
nervousness, insomnia, vertigo, inability to concentrate, lassitude,
indigestion. The condition which we name constipation is therefore one
of supreme importance. From a medical standpoint, it is the biggest
problem in the whole realm of disease. It is the most significant
hygienic function of life, and it is becoming more and more important,
and more and more a problem. Every modern factor upon which physical
efficiency seems to depend is an enemy to the systematic regulation of
this function. Our method of hurried and indiscriminate eating, our
system of strenuous living, our unsanitary environment, our business
activity, our method of pursuing pleasure, take no account of, and
resent the time devoted to cultivating, as a hygienic necessity, this
toilet requirement. This imperative call of nature is pushed aside by
the child at play, by the housewife for a duty which could wait, by the
merchant for an engagement. It is particularly an American disease, and
it is uniquely an American woman's affliction. It is a curious
commentary on the intelligence of the American people, who are
ordinarily alert and analytical, to realize how few of them really know
how serious a matter constipation is. They don't know because they have
given the matter absolutely no thought. They have accepted it as a mere
matter of fact, almost of fate.

INCOMPLETE CONSTIPATION.--There is a type of constipation that is not
known to the average person and not well understood by those few who
know of its existence. In this form of constipation there is a daily
bowel movement but the movement is not complete. The bowel does not
thoroughly empty itself; it has established this habit because of
conditions under which it has had to do its work. If a woman
neglects herself, becomes muscularly inactive, does not take
proper out-door exercise, grows fat and lazy, eats irregularly and
indiscriminately,--the bowel suffers with the rest of the system. The
woman may have a healthy appetite, may eat the wrong things at the wrong
time, yet the bowel is supposed to go on acting rightly, but it does
not. It, too, becomes lazy and acquires bad habits, and this form of
incomplete constipation is the result. These patients look healthy and
get little sympathy for any pains they may have. They may even gain in
weight; they get headaches once in a while, and if they go shopping or
visiting they don't feel quite well afterward. They are suffering from
the effects of chronic constipation, though their bowels are apparently
regular. They are marching onward toward apoplexy or Bright's disease of
the kidney.

IMPORTANCE OF A CLEAN BOWEL.--Every mother, sooner or later, observes
that a physician always thoroughly cleans out the bowel of a sick child
at once, no matter what the character of the sickness is. He does this
for two reasons,--first, because he knows that the great majority of
children's ailments are of gastro-intestinal origin; second, if the
origin of the disease is not in the stomach or bowels, experience has
taught him that if the bowels are clean at the beginning of a disease,
that disease will run a milder and shorter course than if complicated
with a condition of self-poisoning. If a child develops fever the
digestive function stops; whatever food is in the stomach or bowel will
promptly ferment and putrefy because of the abnormal heat caused by the
fever and the arrested digestion. If this is not cleaned out at once the
self-poisoning process begins.

The above is a suggestive admission for a physician to make. It simply
means that the vast majority of the calls made by a physician on ailing
children are caused by errors in diet and can be completely cured by a
dose of castor oil or calomel, or, better still, need never occur.

A mother who neglects, who is guilty of inattention to the conditions of
her child's bowel, fails in one of the most important duties of
motherhood. I know as a father and a physician that if a child's bowel
acts regularly and thoroughly, that child is fortified to the highest
efficient degree against the multitude of little ailments common to all
children. A clean bowel means good blood, good digestion, ability to
exercise properly, to sleep soundly and to think clearly. Such a child
will resist infection and throw off the minor troubles that pave the way
for serious sickness. It is a secret worth knowing.

A DAILY MOVEMENT OF THE BOWEL NECESSARY.--In order to preserve good
health one thorough movement of the bowel is necessary daily. A baby may
have two or three and enjoy robust health. A larger daily number
suggests an abnormal condition of the bowel and an investigation should
be made. If a nursing baby's bowels do not move before bedtime it should
be given an injection of equal parts of glycerine and hot water,
one-half cupful; or an enema of soap and water, or a glycerine
suppository. When a child is six months old, in some sooner, it should
be put on the stool at a certain time every morning. This will aid in
the establishment of the habit, as a child soon understands why it is
made to assume this position and acts accordingly.

The condition referred to above and which we termed incomplete
constipation may affect the nursing infant. A child's bowels may move
daily and yet the child will suffer from constipation. If the movements
are watched it will be observed that certain children strain when at
stool, and after a time succeed in passing hard, dry lumps or balls of
fecal matter. Such a movement is a certain indication that the bowel is
not emptying itself satisfactorily and that a constant toxemia or
poisoning is going on. Very faithful efforts should be made to remedy
this condition by the use of articles of diet that are known to be
laxative, otherwise the condition is one that will "grow" with the child
and establish an obstinate chronic constipation with all its miseries
and dangers.

CONSTIPATION IN BREAST-FED INFANTS.--Many nursing infants thrive and
gain in weight, yet they are constipated. Before you drug your baby be
sure the fault is not your own. Many mothers are responsible for the
constipation with which baby suffers. If the mother is constipated, so
will the child be. Cure the constipation of the mother and the baby's
bowels will regulate themselves. Nursing mothers who are large
tea-drinkers have irregular bowels as a rule. A baby whose mother is
lazy or indolent, who does not take a reasonable amount of exercise,
whose diet is faulty and whose hours are bad, is a sufferer from
constipation. The mother's life must be regulated, her diet and habits
corrected, and the instructions carried out as already recommended. The
breast milk should be examined and if any cause for constipation exists
in it, it should be rectified as suggested elsewhere.

If it is thought advisable to resort to drugs for the immediate relief
of the constipation of infants, the best ones are the aromatic fluid
extract of cascara sagrada; milk of magnesia with equal parts of the
aromatic syrup of rhubarb given in doses of one to three teaspoonfuls
daily.

Irrigations, enemas, and suppositories should not be used continuously.
The habit is a bad one. The parts become accustomed to their use and
fail to act. If the child is passing dry and hard stools it is of
advantage to inject two ounces of warm sweet oil at night, allowing it
to remain in the bowel until the following morning. See page 312.

CONSTIPATION IN BOTTLE-FED INFANTS.--It is much easier to treat the
constipation of bottle-fed babies than of those breast-fed, because the
food can be changed to ensure regular bowel movements. The first change
to be made in a bottle-fed baby who is habitually constipated is to add
more cream to the food. The way to do this is to take out of the bottle
of each feeding one tablespoonful of the food and put in its place one
tablespoonful pure cream. If this change partly rectifies the bowel
ailment, add more cream until the bowels are of the proper consistency.
Milk given constipated babies should be raw, never boiled, as boiled
milk will always aggravate the trouble.

The use of oatmeal water instead of plain water in making the baby's
food may cure the bowel trouble. Taking the sugar of milk out of the
baby's food and putting in its place the same quantity of Mellin's food
will sometimes cure the constipation.

One or two teaspoonfuls of milk of magnesia put into one feeding daily,
or fifteen drops to one tablespoonful of the aromatic fluid extract of
cascara sagrada will move the bowels. Orange juice, strained, two
teaspoonfuls twice daily, is an excellent remedy and should be tried in
every case. Sweet oil and pure cod liver oil, in doses of thirty drops
to two teaspoonfuls three times daily after feedings, if the little
patient is poorly nourished. If the stools remain hard and dry, an
injection of two ounces of warm sweet oil at bedtime is an excellent
method of aiding the bowel. The oil should remain in the bowel all
night. This lubricates the parts, softens the fecal mass and stimulates
the gut to perform its own work. See page 312.

CONSTIPATION IN CHILDREN OVER TWO YEARS OF AGE.--Most children when put
upon a varied diet after the nursing days are over are relieved of any
constipation which may have existed up to that time. There are a few,
however, whose condition does not seem to improve. These children need
attention. We should first insist on regular habits. A child should be
told that its bowels must move every morning after breakfast. If this
is absolutely insisted upon the child will soon recognize the
uselessness of fighting the proposition and submit. If at any time a
conscientious effort is made to move the bowel without result after
fifteen minutes it is wise to use a glycerine suppository so that the
bowel will empty itself.

It has been stated in another part of this book that there are children
with whom milk does not agree. Experience has taught us that milk,
especially milk that has been boiled, causes more cases of constipation
in growing children than all other causes combined. Find out if it is
milk that is the cause in any individual case. While these children
cannot take whole milk just as it comes from the dairy without suffering
in a great many ways, they can take milk and water, or milk and oatmeal
water, prepared in the following way, without becoming constipated. A
bottle of fresh milk is allowed to stand in a cool place for five hours,
when the top ten ounces are skimmed off with a Chapin dipper and mixed
with twelve ounces of oatmeal gruel or plain water. This can be used as
a drink.

Parents can select from the following list of articles such combinations
as may be suitable to constitute the regular meals of a constipated
child:

    Lamb chops.
    Rare steak.
    Rare roast beef.
    Hashed chicken.
    Soft boiled eggs.
    Cracked wheat.
    Hominy.
    Cornmeal.
    Oatmeal, Scotch.
    Bran biscuits.
    Oatmeal crackers.
    Graham wafers.
    Stewed or baked apple.
    Apple sauce.
    Plain vanilla ice cream.
    Animal broths, purées of peas.
    Beans, and lentils.
    Peas.
    String beans.
    Spinach.
    Cauliflower.
    Asparagus.
    Stewed tomatoes, strained.
    Whole wheat bread.
    Zwieback.
    Custard.
    Stewed prunes.
    Junket.
    Cornstarch.

Malted milk is agreeable and advisable as a drink.

Orange juice or a scraped raw apple is allowable at this time.
Constipated children should eat plenty of good butter. Olive oil, two
or three teaspoonfuls after each meal, is excellent. It can be kept up
for months to advantage. Older children may eat raw and cooked fruits,
figs, dates, baked potatoes, poultry, and fish. One or two raw apples or
a peach or orange may be given daily. A strict observance of the above
rules and diet will result in normal movements of the bowel if persisted
in for a reasonable time. It may be necessary occasionally to use a
suppository or an enema now and again until the habit is established.

In children from five to fifteen years of age the use of bran muffins,
with fruit, etc., as described above, will effect a cure of constipation
without having to resort to drugs. I have cured many cases of
constipation in growing children with these muffins without making any
other change in their diet or habits.


RECIPE FOR BRAN MUFFINS

     Take one pint of best flour, one quart unsifted bran, one
     teaspoonful bicarbonate of soda (baking soda), a pinch of salt.
     Mix these thoroughly together, then add: six to eight
     tablespoonfuls good, New Orleans molasses, one pint of milk.
     Mix together very thoroughly. Put in muffin rings and bake in
     oven. About one ounce should be put in each ring as they raise
     easily. Eat with plenty of good butter. They should be given to
     children before each meal, when they are hungry, not after
     their stomachs are full. Put bran in dish first. Sift in flour,
     soda and salt. Mix these thoroughly together, then add one pint
     of milk (two cupfuls) and six to eight tablespoonfuls of New
     Orleans molasses. The quantity of molasses depends upon the
     individual taste. They are good for any child or adult whether
     constipation exists or not.

Drugs may be of temporary service in some cases. A pill of cascara
sagrada is the best for this purpose. It should not be continued for
more than two weeks. Castor oil, calomel, and other frequently-used
cathartics should never be used in simple constipation.


TREATMENT OF OBSTINATE CONSTIPATION

There are cases that resist treatment of the kind described above. Diet
and drugs do not succeed in establishing the habit of daily bowel
movements. In these cases radical treatment is imperative. The diet
should be the same as that described above, but it will be found
advisable to cut out milk altogether. Cereals can be taken with sugar
and butter instead of milk. The oil injection plan of Professor Kerley
has given me excellent results. I quote his comments upon and method of
giving it:--

"OIL INJECTIONS."--"For this purpose a soft-bulb syringe of four ounces'
capacity is ordered. Over the hard rubber tip is place a small sized
adult rectal tube or a No. 18 American catheter. The catheter or tube is
cut so that but nine inches remain for use. The cut end is forced over
the small, hard rubber tip of the syringe. A fountain syringe is
impracticable for this purpose, as it is soon destroyed by the oil and
rendered unfit for use. Besides, sufficient pressure is not produced to
force the oil into the gut even with a high elevation of the bag. The
child is placed on his back or on his left side. The syringe is filled
with oil, the tube is lubricated, and passed through the rectum as far
as it can go. When it has been passed to the full nine inches, as may
readily be done with a little practice, the syringe is emptied and the
tube withdrawn. The injection should be given after the child has been
placed in bed for the night. It is our object to have the oil retained
during the night. If a passage of the bowels is produced at the time, or
if the oil leaks out during the night, a small quantity should be used.
In some of my patients I have been able to use but one ounce. In very
few, indeed, does it cause an evacuation at the time. If there is a
tendency to leakage a napkin should be worn to avoid soiling the
bed-linen. The following morning after breakfast, the child is placed on
the vessel and kept there until a bowel movement results or until
fifteen minutes have elapsed. In a great many cases if the constipation
has been obstinate for months, the bowel will be at once evacuated. When
this does not occur in fifteen minutes, a glycerine suppository is
inserted, which invariably produces an evacuation. This use of the
suppository, according to my observation, can usually be dispensed with
in a very few days; the use of the oil, however, may have to be
continued for several weeks. When the child has had the oil nightly and
an evacuation the next morning without assistance for two weeks, I
direct that the oil be omitted for a night and the effect noted. If the
usual passage occurs after breakfast, the oil is given for five nights
and then omitted. If the case progresses satisfactorily the use of the
oil is gradually omitted, being given at first every second night, then
every third, fourth, or fifth night, etc. A considerable number of cases
have been completely relieved in two months. In the event of no passage
following the omission of the oil, its use is continued for two weeks
longer, when it is again omitted for a night." To illustrate this point
the following case is cited.

"ILLUSTRATIVE CASE.--A boy three years of age had never had a bowel
evacuation without drugs, soap enemas, or suppositories since birth, and
finally these were no longer effective. The mother, thoroughly
frightened, brought the child to me. Eight months of diet and the use of
the oil were required before he was entirely well. It is now three
months since the local treatment was discontinued and the bowel function
remains normal.

"The diet with the absence of milk must be continued for months after
the patient is apparently well, and he must not be allowed to pass a
single morning without an evacuation at the usual time. In assuming the
management of one of these cases I explain to the mother or nurse that
the treatment is not pleasant for the child or the attendant, and that
it may have to be persisted in for weeks, and unless she is willing to
carry it out to the end, it would better not be undertaken. I assure
her, however, that with her coöperation, which is usually readily given,
the child will make a complete recovery. Cases that are slow in
responding to treatment, I usually give the additional advantage of
abdominal massage from twenty minutes to one-half hour, before the child
is placed at stool. The massage should practiced by one skilled in the
work.

"The above local measures apply particularly to children after the
eighteenth month. They may be used earlier, however, following out the
diet along the lines laid down for bottle-fed children who suffer from
constipation. In very young children a smaller amount of oil should be
used, never more than two ounces, usually one ounce is all that is
required. When the oil treatment is under way, whatever the age of the
patient, laxative drugs should not be given."




CHAPTER XXIII

CONSTIPATION IN WOMEN

     Chief Cause of Constipation in Women--Constipation a Cause of
     Domestic Unhappiness--The Requirements of Good Health--The Cost
     of Constipation--Constipation and Social Exigencies--One of the
     Important Duties of Mothers--Constipation and Diseases of
     Women--Constipation is Always Harmful--Constipation and
     Pregnancy--Explanation of Incomplete Constipation--Causes of
     Constipation--Negligence--Lack of Exercise--Lack of Water--Lack
     of Bulk in the Food Taken--Abuse of Cathartic Drugs and
     Aperient Waters--Overeating--Treatment of Constipation in
     Women.


It has been stated that constipation is almost universal among the women
of America. It is a fact that very few American women enjoy, to a
reasonable degree, a permanently satisfactory bowel condition.
Constipation is an acquired habit and unquestionably negligence is the
primary and the chief cause of it. The negligence, no doubt, begins at a
very early age; it is at least an established habit before any
intelligent, consecutive effort is made to remedy it. Inasmuch as women
are the mothers of the race, and as their part in the scheme of life
_is_ the supreme one; and as constipation has been shown to be a
serious, far-reaching, significant disease, a very sincere and
persistent crusade should be made to educate women as to its importance.
For a less altruistic purpose, tremendous popular movements have been
carried to success. For a less service rendered to the race names have
achieved renown. In addition to the symptoms stated in the preceding
paper, the condition which we now desire to emphasize is the effect of
the constant self-poisoning on the general health and its effect upon a
woman's reproductive efficiency.

The poison being constantly absorbed, means general bad health, bad
health to a degree depending upon the degree of constipation which is
the cause of the poisoning. It may be simply that the woman does not
wholly enjoy good health, or that she is completely incapacitated
because of chronic bad health, or any degree of indifferent health
between these two extremes.

If the degree of poison is sufficient to cause habitual poor health, its
effect upon the blood must be bad, and the effect of the bad blood upon
the nervous system and the other vital organs cannot be good. Now if
this process has been going on for many years, the condition of the
woman, who is its victim, as an efficient machine, compared with the
woman in whom this condition never did exist, must be very different
indeed. This condition of affairs--inasmuch as constipation is so common
in women--must have a tremendous significance when estimating the
vitality and efficiency of the coming generation.

We might go much further and yet be sure of our position, and maintain
that it is this national autotoxemia, this scourge of womanhood, that is
to a great extent responsible for the characteristic American "vice of
neurasthenia," and of the domestic infelicity and unhappiness which are
so common in the large cities of this country. If we add to the
intestinal autotoxemia of constipation, the tendency to, or vice of,
indiscriminate eating and drinking--of which the American people are
particularly guilty--we would be on firmer ground. In fact we would feel
that we had pointed out the one underlying cause of most of the domestic
irritability prevalent to-day, which is of serious importance, and which
is, fortunately, capable of correction. It is a matter of everlasting
and continuous education.

THE REQUIREMENTS OF GOOD HEALTH.--There are certain fundamental basic
requirements which are essential to good health: fresh air, good water,
a reasonable amount of physical and mental exercise, nutritious food,
freedom from unnecessary and unreasonable worry, frequent bathing, and a
daily movement of the bowels. The reason why constipation is of such
serious importance is because it is the only basic requirement of good
health that afflicts a large majority of the race at the same time. The
health of so many is being undermined by this one affliction, that it
dominates all other factors that have any bearing upon posterity. A
woman may enjoy all the essential conditions necessary to good health,
yet she may be constipated, and the presence of this condition will
undermine, in her constitution, all the benefits she derives from her
advantageous environments. It will do more; it will be responsible for
the disposition,--the temperament,--of that woman. The natural
disposition of that woman may be an amicable one; if it were allowed to
express itself naturally it would be kind, gentle, considerate,
affectionate. No woman, however, the victim of chronic constipation, can
preserve an equable temperament or an amicable disposition. It is
impossible--with her nerves being constantly poisoned--that she can hold
the symptoms of that condition in abeyance. She must be irritable and
nervous and sick of herself and everything and everybody. The home as a
direct result suffers; its atmosphere is not one of contentment and
peace and affection. Constipation, therefore, blights the home and the
influence of one blighted home may have a far-reaching effect on the
story of the human race. It is responsible also for that woman's mental
attitude outside the home. Instead of exerting an optimistic influence,
her whole existence is a message of pessimism and discouragement.
Multiply these influences and messages to correspond with the prevalence
of the disease and we have a condition that is tremendously significant,
a condition that is really a pressing economic issue. A constipated
woman is an anti-eugenist--a eugenic atrocity.

We have no desire to create a false impression or to build up a foolish
fear. Are we justified in regarding this as one of the most important,
if not the most important, disease condition; the most menacing physical
vice, which the human race has to combat? Let us offer the following
brief facts in witness of our stand:

THE COST OF CONSTIPATION.--It has been estimated that consumption (the
great white plague) kills one-tenth of all the human race. Cancer kills
half as many, or one in every twenty. Constipation, and the diseases
which are caused directly by it, kills one in every three of all the
people on the civilized globe.

Constipation has been responsible for the expenditure of millions of
dollars in advertising in the newspapers alone,--more, probably, than
has been spent in advertising remedies for all other diseases combined.
Do you suppose this money was a donation? Do you suppose these keen,
alert interpreters of the spirit of the times, the up-to-date business
men, were not and are not aware that constipation is the "universal
disease"?

Every drug store, in every civilized spot on earth, has its shelves
loaded down with constipation remedies; dinner pills, liver pills,
cathartic pills, tablets in all possible coatings and combinations,
mineral waters from a multitude of springs, aperient drinks by the
dozen, laxative teas and cordials, cathartic oils and emulsions. If the
demand for these articles should cease most of the drug stores would
close up.

Many millions of dollars have been made and are being made by various
men and concerns, who have devised ingenious mechanical agencies which
are supposed to cure, and in curing renew the lost health caused by
constipation. We have in mind in this connection, a man who conceived
the ingenious plan of putting the opening of an ordinary fountain
syringe in the middle instead of at the end and made a fortune out of
it. In this opening he places an upright nozzle, and instead of hanging
the bag up and allowing the water to run into the bowel, he has the
patient sit on the bag and thereby the water is forced into the bowel.
He has written a two-hundred page book on the advantages of this idea,
and his "literature" contains the names of famous men and women in all
walks of life who use his device. The name of one of the famous judges
of the Supreme Court of the United States was there; another was the
name of a popular operatic beauty who writes for the daily press little
essays on "How to be beautiful!" and "How to keep well!" He deserves his
success. He is an emancipator and has doubtless done a great deal of
good. His success demonstrates, beyond contradiction, the prevalence of
the malady under discussion, and it must be remembered that he is only
one of hundreds who garner from the same ample harvest.

If we could estimate in value the economic loss sustained by the race
because of the inefficiency of the victims of intestinal intoxication,
due to constipation, the sum would be colossal. Even then it would only
represent the direct economic deficiency--it would not express, nor
could any figure adequately represent, the indirect loss sustained by
the race because of the temperamental characteristics, which are the
products of intestinal poisoning, and which produce domestic tragedies
and economic failures.

Has this array of evidence any meaning, or does it just happen to be so?
We leave it to the reader; if it stimulates thought, or pricks a
conscience it will have done its duty.

CONSTIPATION AND SOCIAL EXIGENCIES.--The cause of constipation in women,
whose social station commands every sanitary, hygienic, and dietary
luxury, is their method of living, the food they eat, and the negligence
which is almost obligatory because of social exactions. If constipation
did not so frequently accompany "good" living (which is the modern name
for overeating and drinking) we would have thousands and thousands of
healthy, robust, contented women, fit and willing to assume the onerous
duties concomitant with motherhood. All their enthusiasm, however, is
expended in the effort to keep "in the ring," to overcome the effects of
the poison of constipation, to preserve their youth and freshness, to
undo what neglect has accomplished. It is because of the failure of this
simple function that my lady seeks the masseur, the facial artist, the
society doctor, the beauty expert, and the thousand and one agencies,
which an extravagant and profligate age has made necessary to foster the
efficiency of its votaries.

I am optimistic, however, regarding the future. I believe the human race
is improving, despite the disadvantageous surroundings and conditions
which hamper honest effort and stultify truth. A higher efficiency is
the goal, and the intention is to obtain this desideratum by fair and by
just means. There is an awakening, an unrest, a groping for knowledge in
almost every field of human endeavor, and there is none in which the
yearning for fact, for truth, for instruction, is stronger and keener,
than in the world-wide movement in the interest of a better motherhood,
and in a more serious study of child life. It is an encouraging sign, a
hopeful promise, of what the future has in store.

ONE OF THE IMPORTANT DUTIES OF MOTHERS.--The immediate lesson to be
learnt from the facts just recounted is to instruct mothers in their
duty toward their daughters. If each mother would retain the confidence
of her daughter sufficient to instruct her in the duties which are
important, how much needless suffering would be saved. To know as a
matter of fact whether the daughter's bowels are in good condition will
appeal to all who read this as being of very great importance. It is not
only necessary to know if they have a movement every day, it is
necessary to know the character of the daily movement; whether it is
hard and dry and necessitates straining,--the evil consequences of
which, in young girls, is very serious indeed,--or if it is habitually
loose and suggestive of what has been described as incomplete
constipation.

If the mothers of America would consecrate themselves to this simple
task, who could tell in mere words the effect it would have on the race
yet unborn? There are problems of scientific intent, and of fancy names,
that engage the attention of philanthropically inclined ladies, and
which are emblazoned on the society columns of the daily press, of much
less importance to the human family than the homely duty we ask mothers
to devote themselves to.

CONSTIPATION AND DISEASES OF WOMEN.--Constipation is present in a very
large majority of the cases of diseases of women. It may be caused by
disease of the womb, or it may cause disease of the womb. There is no
question about the bad effect constipation has upon all diseases of this
type. In many cases it is absolutely impossible to effect a cure without
first curing the accompanying constipation.

We seldom appreciate how severe a degree of constipation a growing girl
will submit to without seeking relief. Some of the worst cases of
constipation that have been known, have been in girls between the ages
of sixteen and twenty. The mechanical effects of such a condition can
well be imagined. The constant, severe straining, necessary to evacuate
the bowel, has, in very many instances, produced congestion and
displacement of the womb and ovaries. It is not observed at this time,
or if observed it is not understood, and thus is laid the foundation for
years of neurasthenia, helplessness, and disease.

The more we investigate the ramifications of constipation the more we
learn of its seriousness and of its significance.

CONSTIPATION IS ALWAYS HARMFUL.--There is no period in life when
constipation can be borne with impunity. Youth, with its virility and
vitality, will endure its consequences with an apparent negation, so far
as positive or specific results are concerned, but it is only an
apparent impunity. There is always a certain amount of strength built
up, held in reserve as a heritage of youth, which will withstand a
certain amount of physical license, but if this reserve is assailed by
an unnecessary imposition, and is successfully undermined, there will be
infinitely less reserve to call upon in the legitimate battle of life.
Life is too real, too concentrated, too strenuous, and health is too
precious to be wilfully wasted in any form of self-abuse.

CONSTIPATION AND PREGNANCY.--Mothers will appreciate from the foregoing
explanation why constipation is eugenically a crime during pregnancy.
The evils which result from constipation mechanically, frequently have
serious consequences by interfering with the circulation of the blood to
the womb, by forcing the womb to assume wrong positions, by straining at
stool, and by preventing the kidneys from functionating properly; these
may render the life of the pregnant woman miserable, and may be the
direct cause of a painful, prolonged, difficult labor. The evils which
result from constipation because of the absorption of poisons by the
bowel are of the gravest importance during pregnancy. These poisons
affect the general health; the victim is tired, listless, and apathetic,
and is thereby disinclined to exercise adequately; the appetite is
poor; there are headaches, neuralgias, insomnia, nervousness,
melancholia, and general mental and physical inertness. What hope may a
pregnant woman entertain of having "an easy confinement," or of bringing
a healthy child into the world under these circumstances? Who is to
blame? Sometimes it is necessary to tell the unadorned truth,--the woman
is to blame. No woman has a right to assume the responsibilities of
maternity who has not had enough respect for herself to discontinue
habits which caused this failing, or who has not had strength of will
enough to begin its successful cure. Get busy,--do something,--it is
never "too late," but do it now.

Before we take up the treatment of constipation in women, it is
necessary to explain more fully the type of constipation which we
referred to as "incomplete" constipation. There is a condition of the
bowel, in which we find its wall coated with hard fecal matter. The size
of the bowel may be dilated as a consequence. This condition may occupy
part, or most, of the entire length of the large intestine. In the
middle of this hard mass there is a small channel through which
semi-liquid matter passes. When the bowel moves, it is this semi-liquid
matter that passes out, and this constitutes the daily movement. We have
consequently a condition in which we have a daily movement but not a
complete emptying of the bowel. The character of the stools from such a
bowel must necessarily be more or less of a semi-liquid consistency,
because the intestine, being coated with a hard dried out layer of old
fecal substance, is prevented from absorbing the liquid part of the
fresh fecal mass passing through it. This condition may exist for a
considerable time, but it will slowly undermine the health and vitality
of any person in whom it exists. The symptoms which a patient in this
condition complains of are,--a feeling of being tired and languid, no
energy or vim, headache, loss of appetite, loss of flesh, neuralgic
pains, nausea, vertigo (dizziness), insomnia, frequent colds, cold hands
and feet, biliousness, sallow skin and muddy complexion, liver spots,
coated tongue and a "bad breath," nervousness, melancholia, various
abnormal conditions and diseases of the skin, pimples, blackheads,
eruptions, eczema, piles, appendicitis, diseases of the intestinal wall
as a result of the constipation, Bright's disease of the kidney, and
many other morbid conditions. Any physician could name many symptoms,
which were never properly understood but which are now known to be
caused by the absorption of poisons resulting from inactivity of the
bowels. Patients may not necessarily have all of the above symptoms;
they may have a number of them, or they may have all of them, and they
may have others not mentioned at all.

TREATMENT OF CONSTIPATION IN WOMEN.--To effect a movement of the bowels
in a patient who is a victim of constipation is not a cure. We can
indefinitely cause bowel action by drugs, etc., but the condition will
remain the same or worse. When habitual constipation exists there is an
underlying condition affecting the entire system which indicates that
something is radically wrong. It may be necessary to change the whole
routine of the patient's life. It will certainly be necessary at the
very beginning to inquire into the daily diet, exercise, and
surroundings.

During the past ten years there has been born every few days a new
medical "ism," a new religious cult. Why? Because human nature is an
unstable equation. We are never satisfied with the old order of things
and there will always be a following wherever there is a leader. These
"isms" and cults do not survive. Some seem to thrive, others die a
natural death. There is a law, as old as the hills, that you cannot get
something for nothing in this world. We learn its bitter truth as the
years pass, and when we get over the day dreams and the sentiment of
youth we settle down to real work. If we desire to retain good health,
or regain lost health, we must do something. No one can hand it to us on
a silver plate, nor can anyone work a miracle in our behalf. We cannot
buy health, we must deserve it.

This is the secret of the success of all schemes to cure disease. The
human family will not knuckle down and swallow the truth. The man or
woman in poor health is looking for Aladdin's lamp everywhere and
always. A new bait, dressed up in lubricated, oily words, promising
impossible results, will be accepted as the simple unadorned truth, and
will be bought and paid for, in the end forgotten. The royal road, the
easy road, which they are looking for is impossible. There is no way by
which any one of us may continue to break the laws of nature and retain
or regain our lost health. Miracles are impossible. Prayers without
deeds are empty mouthings and a waste of time. Let us see how this works
out in the treatment of constipation. We must find the cause of the
constipation. I will name the causes in their order of frequency.

NEGLIGENCE.--This is unquestionably the primary cause of almost all
cases of bowel inactivity. As has been already noted, the exigencies of
modern life are of such a strenuous nature that we do not find the time
to devote to this function the degree of systematic attention which it
demands in order to preserve a healthy condition of intestinal
regularity. The bowel is simply a complex muscle controlled by an
elaborate system of nerves of an involuntary type. In order to preserve
the highest degree of efficiency of this complicated mechanism, it must
be permitted to obey the laws nature endowed it with and which it must
obey. When the fecal mass reaches the rectum the nerve centers, acting
through the spinal cord, send a message to the rectum something like
this: "Empty yourself of your contents, we have made all preparations
and everything is ready." The rectum obeys to the extent of notifying
you that it wants to be relieved; you feel the desire to evacuate the
bowels. If you obey, all is well, nature is appeased, you encourage the
systematic regularity necessary to good health. If you do not obey, you
upset the delicate mechanism, and frequent negligence of this character
will result in the complete disarrangement of this complex machinery so
that it will fail to warn you that a bowel movement is necessary and
constipation is established. We must therefore retrace our steps and
re-educate the bowel systematically to empty itself at a certain time
every day. This can be done in nearly every case without artificial
assistance. It may take time but it is worth a little methodical
persistence. The point is, you must do it; no "ism" or esoteric agency
can do it for you.

Mothers will recognize from this explanation the necessity of
establishing the habit in children at the earliest possible moment.

LACK OF EXERCISE.--What does the word exercise imply? It implies
movement, better circulation of the blood, better health and tone to
every part of the body, more oxygen, and a richer, better quality of
blood, and because of a better quality of blood, which is the fuel of
the body machine, we have a better, smoother working machine. Every
human being requires a certain amount of exercise; otherwise the machine
will not run smoothly. If this exercise is not obtained, things begin to
go wrong. One of the very first signs to indicate that the machine is
not running as it ought to run, is a sluggish condition of the whole
digestive apparatus and a certain degree of bowel inactivity
(constipation) follows. There is no substitute for this need. Drugs will
not help you, mechanical devices will not do the work for you, though
they may aid you. You must do the work yourself. If you fail or hesitate
to recognize the truth, if you temporize or procrastinate, you are only
deferring the issue. The argument that you have not the time, that your
work will not permit you, is no argument at all. You must do it or reap
the consequences; you certainly cannot escape them. The wise woman
accepts the situation, the fool goes to an early grave.

LACK OF WATER.--Constipation may be due to a deficiency of water in the
system. Women who suffer from this type do not drink enough water. The
bowel may be willing and able to do its duty, but is handicapped because
a certain amount of liquid is essential to proper digestion and natural
bowel activity. At least six glasses of water should be taken by every
healthy adult human being in each twenty-four hours. The best time to
take this water is as follows: one glass on arising, two between
breakfast and lunch, two between lunch and dinner, and one on retiring.
Between meals means one hour after a meal and at least one-half hour
before the following meal. No liquid should be taken during a meal, or
immediately after, or before a meal. All water taken may be hot or cold,
according to the fancy of the taker. It is of advantage to squeeze the
juice of half a lemon into the water taken on arising if there is any
tendency to constipation or if the liver is lazy or torpid. It is also
good for the complexion.

LACK OF BULK IN THE FOOD TAKEN.--Sometimes the character of the food
taken is such that there is no body to it. The process of digestion so
completely liquefies it that the bowel has no solid matter to
manipulate. To excite the peculiar movements of the intestinal wall
there must be substance in the contents. The variety of the daily food
must be so arranged as to provide this. A list of these foods is
provided elsewhere in this book. Certain other foods stimulate
intestinal activity, not because of their bulk, but because of the
chemical elements they contain. All forms of sugar, the sugars of
fruits, the acids of fruits and vegetables, are excellent natural
laxatives. Sour milk and buttermilk, oils and fats, are also of distinct
value in this respect.

On the other hand, soups, gruels, porridges, and purées are constipating
because the digestive process reduces them to liquids and leaves no bulk
for the bowel to act upon. New bread, hot biscuits, "noodles," and
doughy foods are also objectionable, especially to children. Hot baths,
hot drinks, hot enemas, and sweating are also constipating because they
extract so much liquid from the bowel leaving the contents excessively
dry.

ABUSE OF CATHARTIC DRUGS AND APERIENT WATERS.--This is a widespread
evil; it may justly be regarded as a national curse. The victims of this
custom do not realize that they are addicted to a habit which must be
rightly regarded as equally as bad as the drink habit, so far as its
ultimate effect on the general health and the prospect of longevity is
concerned. Its popularity is a product of our national vice of
indiscriminate eating and drinking. It is more common among the class
who live in restaurants, hotels, and boarding houses, who keep late
hours, eat late suppers and who do not exercise enough. These
individuals eat too much and live too high. After a time the liver
becomes sluggish, the stomach fails to digest properly, the bowels lose
their tone, and flatulent indigestion or some other more or less serious
condition follows; to maintain the pace, to feel and keep fit, they
discover that a glass of some advertised aperient or laxative water
before breakfast works wonders, tides them over for the time being and
keeps them "in the ring." They compliment themselves and push the
specter of age aside.

The thought that they were not "as young as they once were," or that
they must go slow, was not a very pleasing suggestion, so having found a
"cure" by adding another bad habit on top of an existence which is
composed of nothing but bad habits, they start all over again. The
suggestion that their trouble is a warning that "things are going wrong"
and that the whole plan of living must be radically and promptly changed
does not meet with their approval, and so the Department of Health
statistics heap up the records of deaths due to heart disease, hardening
of the arteries, Bright's disease of the kidneys and apoplexy. It is not
a happy tale, but the truth is often tragic.

When a woman finds that her physical efficiency depends upon the
habitual use of cathartic drugs or laxative waters, she must regard the
knowledge with respect, she must give it serious consideration, and she
must adopt means to so change her method of living, that nature will be
given a chance to work in her interest--not against her. Better to find
out exactly where the trouble _is_ now, and go after it than to travel
too far along the wrong road. Many die from the "disease" of
procrastination.

OVEREATING.--Overeating may be included in this classification because
it so overworks the digestive apparatus that it is impossible for it
satisfactorily to complete its function. Any reader desirous of
understanding the full significance of overeating in this connection
should carefully read the article on this subject on pages 289 and 290.

There are, of course, a great many other causes for constipation but
these are the important ones. When we find the cause of any particular
case it will suggest the remedy and we must employ it faithfully if we
hope to effect a cure. If it is negligence, we must correct that fault
and compel our daily routine to accommodate itself to a regular
observance of this function. If it is lack of exercise, we must get more
exercise, or if it is lack of bulk in our food, we must change our
method of living and select with more care the foods we eat. If it is
lack of water, we can correct the constipation by adding the proper
amount of water at the proper time.

A patient who has been a victim of chronic constipation for some time
must live a life somewhat after the following general plan:

She should increase the vegetables, fruits, and fats in her diet and she
should drink enough water. It is a good plan to sip slowly one-half pint
of hot or cold water morning and evening. Daily exercise in the open air
is advisable; exercise of some kind, even if taken indoors, is
imperative. Walking, riding, bicycling, tennis, golf, swimming, are the
best forms of exercise for women. Indoor gymnastics can be made a
satisfactory substitute. After the exercise a hot shower bath and a cold
sponge bath or cold plunge or a swim should follow.

Women in very moderate circumstances may walk briskly a distance of
three or four miles, and on returning can take a warm bath followed by a
brisk rub-off with a coarse towel wrung out of cold water, or they can
use a hose with a spray nozzle and allow the cold water to run over them
for a few seconds after the warm dip in the bath tub. After the adoption
of these measures the bowels may tend to regulate themselves. If so,
this is the proper time to cultivate the habit of regularity, by
selecting a certain time each morning or before retiring for this
function. The patient should go to the toilet at the regular time even
if the desire is not present. By straining slightly, and by encouraging
the voluntary desire, the bowel may receive the necessary stimulation
and an evacuation may result. If there should seem to be no disposition
on the part of the bowel to become accustomed to this procedure, we must
aid it for the time being. A glycerine or soap suppository, a glass of
aperient water, Pluto, Hunyadi, Apenta, or the imported Carlsbad salt in
warm water, or the effervescent Citrate of Magnesium, will result in a
prompt emptying of the bowel. There are a great many other cathartic
drugs and many well-known laxative pills, etc., but these are not
necessary if a systematic effort is being made to cure the constipation,
because success will come within a reasonable time if the patient will
not become unduly discouraged. Many victims are deficient in fat; the
bowel needs lubrication; we therefore recommend a good quality of olive
oil, one tablespoonful after each meal. Frequently it is of advantage to
inject, high up in the bowel, two or three ounces of sweet oil at night,
as is done in children, and which is fully described in the previous
chapter.

If the constipation is due to deranged nerves, in which the reflexes of
the intestinal wall seem to share, we advise massage of the abdomen, and
an occasional hot or cold rectal injection. The proper quantity to use
for this purpose is from two to three quarts. The solution to use is the
normal salt solution. See page 627.

In that form of incomplete constipation in which we stated that there
was a layer of hard, impacted feces covering the bowel wall, a special
method of treatment is necessary. In these cases nothing will succeed as
satisfactorily as very hot, high rectal injections. The object of course
is to rid the bowel of the old, hard, dry mass, which has collected
there, before we can hope to get the bowel into condition to perform its
own work. It is almost incredible that the human bowel can hold so much
old dried-out, nasty stuff as is stored up in these constipated bowels.
Hot salt water, as hot as can be tolerated, two or three quarts at a
time, is the correct way to dislodge this mass. It will not be done at
once; it frequently takes two or three weeks before the bowel is fairly
clean. The irrigations should be given every second night until the
bowel is clean. The method of giving these washings is fully described
on page 312. While these irrigations are being given the patient should
take olive oil by the mouth, one tablespoonful after each meal. The
proper food, open-air exercise, sanitary living, plenty of water, and
regular attention to the bowel movements will in the end cure the
affliction.